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Open Access Highly Accessed Research article

The cost of a primary care-based childhood obesity prevention intervention

Davene R Wright1*, Elsie M Taveras2, Matthew W Gillman34, Christine M Horan2, Katherine H Hohman5, Steven L Gortmaker6 and Lisa A Prosser37

Author Affiliations

1 Department of Pediatrics, University of Washington School of Medicine, PO Box 5371, M/S: CW-8-6, 98145-5005 Seattle, Washington, USA

2 Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USA

3 Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA

4 Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA

5 Healthy Living Department, YMCA of the USA, Chicago, Illinois, USA

6 Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA

7 Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA

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BMC Health Services Research 2014, 14:44  doi:10.1186/1472-6963-14-44

Published: 29 January 2014

Abstract

Background

United States pediatric guidelines recommend that childhood obesity counseling be conducted in the primary care setting. Primary care-based interventions can be effective in improving health behaviors, but also costly. The purpose of this study was to evaluate the cost of a primary care-based obesity prevention intervention targeting children between the ages of two and six years who are at elevated risk for obesity, measured against usual care.

Methods

High Five for Kids was a cluster-randomized controlled clinical trial that aimed to modify children’s nutrition and TV viewing habits through a motivational interviewing intervention. We assessed visit-related costs from a societal perspective, including provider-incurred direct medical costs, provider-incurred equipment costs, parent time costs and parent out-of-pocket costs, in 2011 dollars for the intervention (n = 253) and usual care (n = 192) groups. We conducted a net cost analysis using both societal and health plan costing perspectives and conducted one-way sensitivity and uncertainty analyses on results.

Results

The total costs for the intervention group and usual care groups in the first year of the intervention were $65,643 (95% CI [$64,522, $66,842]) and $12,192 (95% CI [$11,393, $13,174]). The mean costs for the intervention and usual care groups were $259 (95% CI [$255, $264]) and $63 (95% CI [$59, $69]) per child, respectively, for a incremental difference of $196 (95% CI [$191, $202]) per child. Children in the intervention group attended a mean of 2.4 of a possible 4 in-person visits and received 0.45 of a possible 2 counseling phone calls. Provider-incurred costs were the primary driver of cost estimates in sensitivity analyses.

Conclusions

High Five for Kids was a resource-intensive intervention. Further studies are needed to assess the cost-effectiveness of the intervention relative to other pediatric obesity interventions.

Trial registration

ClinicalTrials.gov Identifier: NCT00377767.

Keywords:
Child; Preschool; Obesity; Cost; Economic evaluation