Elsevier

Ambulatory Pediatrics

Volume 8, Issue 5, September–October 2008, Pages 336-341
Ambulatory Pediatrics

Insurance, Information Technology, Economics of Interventions
Economic Evaluation of a Primary Care Trial to Reduce Weight Gain in Overweight/Obese Children: The LEAP Trial

https://doi.org/10.1016/j.ambp.2008.06.006Get rights and content

Background

A common policy response to the childhood obesity epidemic is to recommend that primary care physicians screen for and offer counseling to the overweight/obese. As the literature suggests, this approach may be ineffective; it is important to document the opportunity costs incurred by brief primary care obesity interventions that ultimately may not alter body mass index (BMI) trajectory.

Methods

Live, Eat and Play (LEAP) was a randomized controlled trial of a brief secondary prevention intervention delivered by family physicians in 2002–2003 that targeted overweight/mildly obese children aged 5 to 9 years. Primary care utilization was prospectively audited via medical records, and parents reported family resource use by written questionnaire. Outcome measures were BMI (primary) and parent-reported physical activity and dietary habits (secondary) in intervention compared with control children.

Results

The cost of LEAP per intervention family was AU $4094 greater than for control families, mainly due to increased family resources devoted to child physical activity. Total health sector costs were AU $873 per intervention family and AU $64 per control, a difference of AU $809 (P < .001). At 15 months, intervention children did not differ significantly in adjusted BMI or daily physical activity scores compared with the control group, but dietary habits had improved.

Conclusions

This brief intervention resulted in higher costs to families and the health care sector, which could have been devoted to other uses that do create benefits to health and/or family well-being. This has implications for countries such as the United States, the United Kingdom, and Australia, whose current guidelines recommend routine surveillance and counseling for high child BMI in the primary care sector.

Section snippets

Methods

The LEAP randomized controlled trial was conducted during 2002–2003 in 29 family medical practices in Melbourne, Australia. Detailed methods and processes of the randomized controlled trial are reported elsewhere.21 Briefly, in early 2002, 34 GPs were recruited into LEAP and took part in a series of three 2.5-hour educational sessions at local venues; a range of adult learning styles were used. All 34 GPs attended at least 2 of the 3 education sessions and 75% attended all 3, with 85% reporting

Results

Audit data were available for all 82 intervention and 81 control children, and parent questionnaire data were available for 65 (79%) intervention and 72 (89%) control children at 9 months and for 64 (78%) intervention and 70 (86%) control children at 15 months.

Table 1 summarizes LEAP program delivery costs. The total cost of providing the LEAP intervention was AU $57 812. This equates to AU $1994 per participating practice, AU $1700 per GP trained, or AU $705 per intervention child (Table 2).

Discussion

From a combined health sector and family perspective, the cost of LEAP per intervention child was AU $4094 greater than for children of control families, largely as a result of increased family resources devoted to child physical activity. Total costs borne by the health sector were AU $873 per intervention family and AU $64 per control. This investment did not improve the primary outcome measure of child BMI in the intervention group relative to controls at 9 or 15 months, although there was

Acknowledgments

Funding was provided by the Public Health Postgraduate National Health and Medical Research Council Scholarship (216745) to Z.M. and by National Health and Medical Research Council Career Development Award (284556) to M.W. The LEAP Trial was funded by a grant from the Australian Health Ministers Advisory Council for Priority Driven Research (AHMAC PDR 2001/15; Melissa Wake, Elizabeth Waters, Zoë McCallum). We thank the participating general practitioners and families. We would also like to

References (32)

  • T.J. Cole et al.

    Establishing a standard definition for child overweight and obesity worldwide: international survey

    BMJ

    (2000)
  • Child Trends DataBank. Number of children. Available at:...
  • R.C. Whitaker

    Obesity prevention in pediatric primary care: four behaviors to target

    Arch Pediatr Adolesc Med

    (2003)
  • R.P. Schwartz et al.

    Office-based motivational interviewing to prevent childhood obesity: a feasibility study

    Arch Pediatr Adolesc Med

    (2007)
  • M. Westwood et al.

    Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence

    Arch Dis Child

    (2007)
  • UK Department of Health. Obesity care pathway and your weight, your health. Available at:...
  • Cited by (0)

    View full text