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:
a) The perspective of the study: Consider cost of obesity to the individual with illness or
to the society as a whole
b) 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
c) The analysis time frame: You need to decide how long we should wait to see changein 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).
d) Data on all types of costs to be collected: including costs relating to actual implementation of the treatments.
e) Data on relevant health outcomes within each of the following time frames: shortterm (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 regard
This is a Case Study, and the structure should be roughly as follows:
(1) Introduction (should be short and crisp, state the background around the intervention, and provide a motivation for an economic evaluation of the same);
(2) Literature (cite similar studies – do some research, narrate the findings in own words, instead of quoting them verbatim). Remember, unless you back-up your argument, it is just your opinion;
(3) Issues – mainly discuss issues relating to the potential benefits (direct and indirect) and costs (direct and indirect).
(4) Analysis (here you present the numbers from secondary sources, and based on these numbers conduct the economic evaluation)
(5) Recommendation in the light of your analysis (whether BMI screening only is cost effective).
Successful identification and subsequent treatment of disordered eating and weight control behaviours have a direct impact on preventing its progression and reducing the chronic health issues risks. According to Haines et al. (2011), this is by ensuring a significant reduction on the amount of time spent from the symptom onset and treatment improving the clinical response and long-term complications of clinical and subclinical eating disorders. Screening in schools is particularly critical as the majority of individuals with high BMI develop it at that level. This is since schools have a large population often without access to the health care system or seeking care and the support staff such as the school nurses being ideally positioned in referring and supporting students identified as being at risk for eating disorders. The eating disorders are costly and increase the burden level on the patients and their caregivers. For instance, Wright et al. (2014) pointed out that the annual impact of the EDs on health care costs and economic productivity in Australia and England are ranging from the US $1.8 billion to $19.2 billion. Hence, it is instrumental to carry out an economic evaluation to identify the success of such strategies used and economic gains in the society in entirety.
2.0 Literature Review
2.1 Screening of BMI in Schools
From the reviewed studies, the majority have focused on the screening measures for eating disorders among the adult samples primarily comprised of young adult women (Ashwell et al., 2012; Hasler et al., 2004; Peterson et al., 2004). Nevertheless, only a limited number of studies have focused on examining the adoption of the screening items in a population-based study of adolescents. The studies that have focused on evaluating the school-based BMI assessment for the screening and surveillance is viewed as a potentially critical aspect of a multifaceted strategy to reduce child and adolescent overweight and obesity (Stalter et al., 2010; Thompson & Card-Higginson, 2009). The rationale of the findings of the studies is informed by the fact that the school-based BMI screening has a potential for parental and child health education and an address of the increasing levels of disparities in child obesity. Further, the BMI screening offers information on the student health assisting the local authorities and schools to implement policies and programs. The outcome of this as noted by (Stalter et al., 2010; Raczynski et al., 2009) contributes to promotion of healthy behaviours which are ideal for districts or particular schools. Despite the potential of improving the health outcomes of individuals through school screening, the majority of the studies have failed in introducing school-based BMI screening and concerns on the problem. The issues pertaining to legal and reporting issues, the potential for increased rates of eating disorders and actual challenges of measuring the BMI in schools (Ikeda et al., 2006; Story et al., 2009). It is evident from the reviewed studies that since the early 1990s, there have been multiple school-based dietary and physical activities for promoting programs developed, implemented and evaluated in the entire country (Dobbins et al., 2013; Beets et al., 2009; Gonzalez-Suarez et al., 2009). An appropriate example is the Gortmaker et al. (1999) economic evaluation techniques used in establishing the cost-effectiveness and cost-benefit of Plant Health as a school-based intervention for reducing obesity among the youth of Middle-School age. This was an interdisciplinary curriculum integrating the different subject areas into active physical education.
2.2 Economic Aspect of BMI Screening in Schools
The issue of overweight amongst children and adolescents has been a critical health issue in the last two decades. In one of the study by McAuley et al. (2010), it has been pointed out that the 1999 National Health and Nutrition Examination Survey (NHANES) statistics indicated that 13% of the children have 6 to 11 years of age with the 14% of adolescents aged 12 to 19 years being overweight identified as age and sex-specific BMI higher than or equal to 95th percentile. From these statistics, there are health and economic implications. According to Packham, A., & Street (2019), overweight children suffer an increased risk of becoming overweight or obese adults particularly if they are overweight at the adolescent stage. Further, Packham and Street (2019) study pointed out that obesity in adulthood is a critical risk factor for different chronic disease conditions such as coronary heart disease, type 2 diabetes, hypertension, selected cancers, musculoskeletal disorders and the all-cause mortality. The consequence of all the outcomes of the overweight leads to distinct economic issues with direct implication on the individual, societal and national economic well-being. In the USA, a 2017 report by American Diabetes Association (2018) has noted that the overall estimated cost of diagnosed diabetes is $327 billion and inclusive of $237 billion in direct medical costs and $90 billion in reduced productivity. This is approximately 4 health care dollars in the US and more than half of the entire expenditure directly budgeted for healthcare. Hence, successful identification of obesity at the adolescent stage, the probability of successful attainment of ideal body weight is improved. As such, theoretically, prevention of the children and adolescence is a critical factor on the adult morbidity and mortality rates. Despite the different school-based obesity prevention programs directly decreasing the BMI among intervention students (El-Kassas & Ziade, 2017; Blaine et al., 2017), there exists a research gap on their cost-effectiveness. It can be argued based on the available research that limitation of resources for obesity prevention activities would create an ideal opportunity for implementing all effective programs without a concern on their expense. Nevertheless, the limited resources in public health globally lead to prevention being idealized as being effective and cost-effective.
For the direct potential benefits, the children undergoing BMI screening benefit from significant physical and psychosocial health risks which are often evident in an event they are associated with overweight in their childhood. This would be mitigated from recurring in their adulthood (Kalich et al., 2008). Also, the children would directly benefit from an increased family awareness on their weight status hence motivating their family in taking appropriate actions for addressing the child potential weight issues. From an indirect perspective, the school-based BMI screening would be used as an appropriate tool for assisting direct combat of the obesity epidemic being actively tempered by issues of the potential of suffering from the unintended negative consequences. Additionally, the policymakers and other institutions of the government would end up recommending to school-aged children actively screening for overweight issues. This is particularly the school administrators and government policy maker’s end up sourcing relevant information for their impact.
In regard to direct costs, the lost productivity would include the costs associated with lost or impaired ability for working or engaging in leisure activities due to morbidity and lost economic productivity due to death. For instance, Rosekind et al. (2010) study pointed out that the costs of lost productivity as a consequence of morbidity are estimating the use of BMI cutoff level of approximately 27.3 kg/m squared. In the context of the indirect costs, the medical costs involved in the intervention are directly linked with a woman being overweight as opposed to not being overweight. A study such as Cawley and Meyerhoefer (2012) has linked the lifetime health and economic consequences of obesity which are linked to the events of fatal and nonfatal coronary heart disease, hypertension, diabetes, symptomatic gallstones, and osteoarthritis all projected to exist in a 25 year period.
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