Pediatric Obesity/Public Health
Utility values for childhood obesity interventions: a
systematic review and meta-analysis of the evidence for
use in economic evaluation
V. Brown
1,2
, E. J. Tan
2,3
, A. J. Hayes
2,3
, S. Petrou
2,4
and M. L. Moodie
1,2
1
Deakin Health Economics, Global Obesity
Centre (GLOBE), Centre for Population Health
Research, Deakin University, Geelong, Victoria,
Australia,
2
Centre for Research Excellence in
Early Prevention of Obesity in Childhood,
Sydney, NSW, Australia,
3
School of Public
Health, The University of Sydney, Sydney, New
South Wales, Australia, and
4
Warwick Medical
School, University of Warwick, Coventry, UK
Received 26 October 2017; revised 12
December 2017; accepted 19 December 2017
Address for correspondence: V Brown, Deakin
Health Economics, Centre for Population Health
Research, Deakin University, Geelong Victoria
3220 Australia.
E-mail: victoria.brown@deakin.edu.au
Summary
Rigorous estimates of preference-based utilities are important inputs into economic
evaluations of childhood obesity interventions, yet no published review currently
exists examining utility by weight status in paediatric populations. A comprehen-
sive systematic literature review and meta-analysis was therefore undertaken,
pooling data on preference-based health state utilities by weight status in children
using a random-effects model. Tests for heterogeneity were performed, and publica-
tion bias was assessed. Of 3,434 potentially relevant studies identified, 11 met our
eligibility criteria. Estimates of Cohen’s d statistic suggested a small effect of weight
status on preference-based utilities. Mean utility values were estimated as 0.85
(95% uncertainty interval [UI] 0.84–0.87), 0.83 (95% UI 0.81–0.85), 0.82 (95%
UI 0.79–0.84) and 0.83 (95% UI 0.80–0.86) for healthy weight, overweight, obese
and overweight/obese states, respectively. Meta-analysis of studies reporting utility
values for both healthy weight and overweight/obese participants found a statisti-
cally significant weighted mean difference (0.015, 95% UI 0.003–0.026). A small
but statistically significant difference was also estimated between healthy weight
and overweight participants (0.011, 95% UI 0.004–0.018). Study findings suggest
that paediatric-specific benefits of obesity interventions may not be well reflected
by available utility measures, potentially underestimating cost-effectiveness if
weight loss in childhood/adolescence improves health or well-being.
Keywords: Health-related quality of life, paediatric obesity, systematic review,
utility.
Abbreviations: 95% UI, 95% uncertainty interval; BMI, body mass index; CEA,
cost-effectiveness analysis; CHU-9D, Child Health Utility 9D; CUA, cost–utility
analysis; EQ-5D-Y, EuroQol 5D Youth; HRQoL, health-related quality of life;
HUI, Health Utilities Index; MAUIs, multi-attribute utility instruments; QALY,
quality-adjusted life year; WMD, weighted mean difference.
Introduction
Childhood overweight and obesity is a serious global pub-
lic health challenge (1). Given society’s scarce resources,
rigorous economic evaluation of childhood obesity preven-
tion and treatment interventions is a useful tool for
priority setting. Cost–utility analysis (CUA) is a form of
economic evaluation that compares the costs of an inter-
vention with the benefits gained, incorporating interven-
tion impact on both the quality and quantity of life.
CUA allows for comparison of cost-effectiveness across
healthcare programmes and is used as a tool for allocating
health resources by governments, including in Australia
and the UK (2,3).
obesity reviews
doi: 10.1111/obr.12672
© 2018 World Obesity Federation Obesity Reviews 19, 905–916, July 2018
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