Modelling the cost-effectiveness and equity impact of strategies to prevent childhood obesity in Australia

Abstract

In Australia, 25% of children have overweight or obesity with impacts on short and long-term health. This burden is coupled with distinct and growing socioeconomic inequalities in child adiposity. While there were no observable inequalities two decades ago, Australian children from low versus high socioeconomic backgrounds are now twice as likely to experience obesity. Despite decades of research into childhood obesity prevention strategies, the best interventions to address the burden and inequities are unclear. The aim of this thesis was to develop a model (the EQ-EPOCH model) to facilitate equity-informative economic evaluations of childhood obesity interventions in a consistent and comparable way. In the first two studies of this thesis, age trends in inequalities of BMI growth rate were examined and the findings informed a core model predicting BMI and overweight and obesity by socioeconomic position from age 5 to 17 years. In the next two studies, age trends in the relationship between child weight status and health-related quality of life (HRQoL), with two measures of HRQoL, were examined. These studies produced unexpected findings which informed how utilities were incorporated into the EQ-EPOCH model. In the last two studies, two different types of equity-informative economic evaluations of childhood obesity interventions were conducted using the EQ-EPOCH model: 1. An economic evaluation of an infant sleep intervention across socioeconomic groups and 2. distributional cost-effectiveness analyses of three interventions. Both evaluations modelled outcomes until age 17 and identified efficient and equitable interventions. The model developed will facilitate the rapid generation of comparable evidence on the efficiency and equity characteristics of interventions to address obesity in childhood. With this evidence, policy-makers will be well-equipped to identify the most cost-effective and equitable strategies to tackle the childhood obesity problem in Australia.