Cost-Effectiveness Modelling Of Childhood Obesity Health Promotion Programs: Comparison Between Sahabat Sihat And Be Best 2012
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Date
2015-05
Authors
CHIN CHOON, LIM
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Abstract
Childhood obesity prevalence is high worldwide and associated with cardiovascular
diseases necessitating preventive measures such as health promotion programs. Some
programs are effective but costly and some programs are economical but not effective.
The general objective of this research was to evaluate the cost effectiveness of
childhood obesity health promotion programs.
This was a quasi-experimental study with convenient sampling that involved the
comparison of intermediate and final outcomes between two pilot studies for childhood
obesity health promotion programmes (Sahabat Sihat (SS) and Be Best (BB)). In
Intermediate quasi-experimental study, primary outcomes (knowledge, attitude and
practice (KAP) of obesity prevention) and secondary outcomes (bioclinical,
anthropometric and quality of life data) of participants’ pre and post intervention were
collected. In lifetime evaluation, a Markov model with emphasis on health states related
to cardiovascular events was developed from systematic review and expert opinion.
Finally, intermediate and long term cost-effectiveness analysis was performed from the
payor’s (MySihat) perspectives. Ninety eight students participated in the SS programme
while 112 students participated in the BB programme.
Analysis of the KAP Questionnaires shows that there are statistically significant
differences (p<0.05) in the mean knowledge [baseline (mean = 70.9%); after three
months (mean = 79.0%); final study (mean = 80.3%)], attitude [baseline (mean =
76.0%); after three months (mean = 76.6%); final study (mean = 72.3%] and practice
[baseline (mean = 55.3%); after three months (mean = 60.3%); final study (mean =
51.8%)] scores at the baseline, after three months and at the final study for BB
participants. However, there were 0% and 28% reductions in the number of obese
cohorts after six months for SS and BB cohorts. The mean total cost per participant for
SS and BB were MYR516.59 and MYR433.96 respectively. The differences in costs
between SS and BB were MYR82.63 per participant. A Markov model with health
states for childhood obesity, obesity, diabetes mellitus, hypertension,
hypercholesterolemia and cardiovascular diseases (encompassing myocardial infarction
and stroke) was developed from systematic review and expert opinion. The Markov
model were confirmed with verification, between model and external validation
processes. In intermediate cost effectiveness study, BB dominate in the cost
effectiveness plane compared to SS in terms of reduction in obesity percentage and
increase in knowledge and practice domain while the ICER is MYR 9 for each
percentage change in the attitude domain score compared to SS. In long term cost
effectiveness study, SS is in extended dominance while the ICER of BB compared to SS
is MYR 9200. BB is not cost effective compared to no program at the cost-effectiveness
threshold of MYR29000. Threshold analysis shows that BB will be below the threshold
if cost per participant is below MYR 300. However, there is a lack of continuity,
follow-up and implementation of interesting activities in SS and BB to encourage a
change in attitude and practice, which resulted in high drop-out and low reduction in
childhood obesity rate. This economic analysis suggests that less costly or more
effectively conducted health promotion than BB is required for the long-term prevention
of childhood obesity in Malaysia.
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Cost-Effectiveness Modelling Of Childhood Obesity Health Promotion Programs , Comparison Between Sahabat Sihat And Be Best 2012