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)

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 6months, 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

Study selection flowchart for review.

<p>Study selection flowchart for review.</p

Forest plot of meta-analysis of mean IQ estimates by organism.

<p>Abbreviations: <i>Haemophilus influenzae</i> b (Hib), <i>Streptococcus pneumoniae</i> (SP) <i>Neisseria meningitides</i> (NM), group B streptococcus (GBS)</p

Forest plot of meta-analysis of weighted mean difference in IQ between meningitis survivors and controls by organism.

<p>Abbreviations: <i>Haemophilus influenzae</i> b (Hib), <i>Streptococcus pneumoniae</i> (SP) <i>Neisseria meningitides</i> (NM), group B streptococcus (GBS)</p

Developmental delay (DD) by organism and developmental domain in CC and cohort studies.

<p>Developmental delay (DD) by organism and developmental domain in CC and cohort studies.</p

Forest plot of mean difference in Verbal and Performance IQ between meningitis survivors and controls by organism.

<p>Panel A shows Verbal IQ and Panel B shows Performance IQ. Abbreviations: <i>Haemophilus influenzae</i> b (Hib), <i>Streptococcus pneumoniae</i> (SP) <i>Neisseria meningitides</i> (NM), group B streptococcus (GBS); weighted mean difference (WMD)</p

Forest plot of relative risk of low IQ (IQ<70) in meningitis survivors compared with controls by organism.

<p>Abbreviations: <i>Haemophilus influenzae</i> b (Hib), <i>Streptococcus pneumoniae</i> (SP) <i>Neisseria meningitides</i> (NM), group B streptococcus (GBS)</p

Full scale IQ: Mean IQ and proportions with low IQ (≤70) by organism.

<p>Full scale IQ: Mean IQ and proportions with low IQ (≤70) by organism.</p

Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT

Background: Five linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway. Objectives: (1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E). Methods: Five substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre. Results: Study A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primary outcome) when compared with enhanced usual care. Study D – anti-obesity drugs appear efficacious in meta-analysis, and their use has expanded rapidly in the last decade. However, the majority of prescriptions are rapidly discontinued after 1–3 months of treatment. Few young people described positive experiences of anti-obesity drugs. Prescribing was rarely compliant with the National Institute for Health and Care Excellence guidance. Study E – bariatric surgery appears safe, effective and highly cost-effective in adolescents in the NHS. Future work and limitations: Work is needed to evaluate behaviour and body mass index change in the National Childhood Measurement Programme more accurately and improve primary care professionals’ understanding of the National Childhood Measurement Programme feedback, update and further evaluate the Computer-Assisted Treatment of CHildren (CATCH) tool, investigate delivery of weight management interventions to young people from deprived backgrounds and those with significant psychological distress and obtain longer-term data on anti-obesity drug use and bariatric surgery outcomes in adolescence. Trial registration: Current Controlled Trials ISRCTN99840111