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Cost-effectiveness of a community-delivered multicomponent intervention compared with enhanced standard care of obese adolescents: cost-utility analysis alongside a randomised controlled trial (the HELP trial)
  1. Monica Panca1,
  2. Deborah Christie2,
  3. Tim J Cole3,
  4. Silvia Costa3,
  5. John Gregson4,
  6. Rebecca Holt3,
  7. Lee D Hudson5,
  8. Anthony S Kessel6,
  9. Sanjay Kinra4,
  10. Anne Mathiot3,
  11. Irwin Nazareth1,
  12. Jay Wataranan3,
  13. Ian Chi Kei Wong7,
  14. Russell M Viner3,
  15. Stephen Morris8
  1. 1 Department of Primary Care and Population Health, UCL Institute of Epidemiology and Health Care, London, UK
  2. 2 Child and Adolescent Psychological Medicine, University College London Hospitals, London, UK
  3. 3 Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
  4. 4 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  5. 5 Great Ormond Street Hospital for Children, London, UK
  6. 6 Public Health England, London, UK
  7. 7 Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
  8. 8 Department of Applied Health Research, UCL Institute of Epidemiology and Health Care, London, UK
  1. Correspondence to Monica Panca; m.panca{at}ucl.ac.uk

Abstract

Objective To undertake a cost-utility analysis of a motivational multicomponent lifestyle-modification intervention in a community setting (the Healthy Eating Lifestyle Programme (HELP)) compared with enhanced standard care.

Design Cost-utility analysis alongside a randomised controlled trial.

Setting Community settings in Greater London, England.

Participants 174 young people with obesity aged 12–19 years.

Interventions Intervention participants received 12 one-to-one sessions across 6 months, addressing lifestyle behaviours and focusing on motivation to change and self-esteem rather than weight change, delivered by trained graduate health workers in community settings. Control participants received a single 1-hour one-to-one nurse-delivered session providing didactic weight-management advice.

Main outcome measures Mean costs and quality-adjusted life years (QALYs) per participant over a 1-year period using resource use data and utility values collected during the trial. Incremental cost-effectiveness ratio (ICER) was calculated and non-parametric bootstrapping was conducted to generate a cost-effectiveness acceptability curve (CEAC).

Results Mean intervention costs per participant were £918 for HELP and £68 for enhanced standard care. There were no significant differences between the two groups in mean resource use per participant for any type of healthcare contact. Adjusted costs were significantly higher in the intervention group (mean incremental costs for HELP vs enhanced standard care £1003 (95% CI £837 to £1168)). There were no differences in adjusted QALYs between groups (mean QALYs gained 0.008 (95% CI −0.031 to 0.046)). The ICER of the HELP versus enhanced standard care was £120 630 per QALY gained. The CEAC shows that the probability that HELP was cost-effective relative to the enhanced standard care was 0.002 or 0.046, at a threshold of £20 000 or £30 000 per QALY gained.

Conclusions We did not find evidence that HELP was more effective than a single educational session in improving quality of life in a sample of adolescents with obesity. HELP was associated with higher costs, mainly due to the extra costs of delivering the intervention and therefore is not cost-effective.

Trial registration number ISRCTN99840111.

  • childhood obesity
  • cost-effective
  • cost-utility
  • qaly

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Contributors MP undertook the economic analysis and drafted the paper with input from all authors, and is the guarantor. DC conceptualised the trial, developed the trial design and intervention and revised the paper. TJC contributed to the trial design, developed the trial statistical plan and revised the paper. SC and JW monitored the data collection, cleaned the data and revised the paper. JG developed the trial statistical plan and revised the paper. RH supervised the providers and revised the paper. LDH, AK and AM contributed to trial design, writing of the protocol and revised the paper. SK, ICKW and IN contributed to the trial design and revised the paper. RMV conceptualised the trial, developed the trial design and intervention, developed the trial statistical plan and revised the paper. SM contributed to the trial design, developed the health economic plan and drafted and revised the paper.

  • Funding This work was supported by the NIHR under its Programme Grants for Applied Research programme (Grant Reference Number RP-PG-0608-10035)—the Paediatric Research in Obesity Multi-model Intervention and Service Evaluation (PROMISE) programme). The HELP research team acknowledges the support of the NIHR through the Primary Care Research Network. TJC was funded by MRC grant MR/M012069/1.

  • Disclaimer The views represented in this paper are those of the authors and not necessarily represent those of PHE, NHS, the NIHR or the Department of Health.

  • Competing interests AK is Director of International Public Health at Public Health England (PHE).

  • Patient consent Not required.

  • Ethics approval National Research Ethics Service, West London REC 3, on 27 August 2010. Research Ethics Committee (REC) reference number 10/H0706/54.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

  • Correction notice Since this article was first published online the open access licence has been updated to CC-BY.

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