Task: With the increase in the prevalence of obesity among children and adolescents over the past several decades in the United States and across the globe, researchers, medical providers, and governments worldwide are seeking novel methods to address this epidemic. The use of body mass index (BMI)report cards, where schools weigh and measure students and send parents an assessment of their child’s risk for obesity, is one method that has been popular across the United States and internationally. Experts agree that parents should be informed of their child’s weight status, yet there is considerable debate about how this information should be presented to parents and from whom it should come. Although several states have implemented BMI report card programs, few peer-reviewed studies evaluating their effectiveness have been published to date. Early recognition of the risk factors associated with adolescence obesity and timely intervention could decrease the economic and health burden of obesity on the population. Although population-based screening for BMI has been validated as a feasible method to identify at-risk adolescents who might benefit from early identification and treatment, BMI screening has historically not been conducted as part of routine school-based health screenings in Australia.
Suppose your state premier signed a bill that requires information on child BMI and the associated risk factors to be sent to parents of the state public school students in grades 5-12. The law also calls for the state Health department to work with the Child Care National Association and other stakeholders to develop a plan for implementing BMI screenings in schools.
Suppose you are a health economist at the state Department of Health, and is responsible for the economic evaluation for this project. Assume that the screenings will take place once a year. Further assume that that all children with BMI over 95th percentile in their age-adjusted scale will go on to enroll in a targeted health programme (e.g., behavioural therapy) funded by the state within the year of screening.
Economically evaluate the suggested BMI screening intervention at school for students in grades 5-12 using cost-effectiveness or cost-utility analysis. Outline the recommendations you would make. Support your analysis, evaluation, and recommendations through reference to the existing cost effectiveness literature.
Please consider the following key issues as you undertake your analysis:
- The perspective of the study: Consider cost of obesity to the individual with illness or to the society as a whole
- The intervention time frame: The period should be sufficiently long to cover program start-up phase and full program implementation (with ongoing costs and school schedule).
- The analysis time frame: You need to decide how long we should wait to see change in outcome of interest if the intervention is successful. For prevention strategies, the time frame should capture all potential costs and benefits of the program. However, you must consider how realistic and feasible data collection will be (i.e., very few outcomes might be detectable within a short period after screening, but very long-term follow up may not be feasible).
- Data on all types of costs to be collected: including costs relating to actual implementation of the treatments.
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- Data on relevant health outcomes within each of the following time frames: short term (e.g., one month), intermediate (e.g., one year), and long term (e.g., 10 years or lifetime). Rank the outcomes identified in (e) on the level of appropriateness for CEA. How feasible is it to obtain data on outcomes you have identified? If too difficult, what are the alternative outcomes that will still reflect the outcome of interest? What assumptions are you making regarding the alternatives as proxies for outcome of interest?