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. Eating disorders, while less common than obesity, are prevalent among adolescents. Eating disorders are a source of substantial morbidity and mortality and are costly to treat. Early diagnosis and timely treatment could decrease the economic and health burden of eating disorders on the population. Although population-based screening for eating disorders has been validated as a feasible method to identify at-risk adolescents who might benefit from early identification and treatment, eating disorder screening has historically not been conducted as part of routine school-based health screenings in the United States. In March of 2013, Virginia Governor Bob McDonnell signed a bill that requires information about eating disorders to be sent to parents of Virginia public school students in grades 5-12. The law also calls for the Virginia Department of Health to work with the National Eating Disorders Association and other stakeholders to develop a plan for implementing eating disorder screenings in schools.
Suppose you are a health economist at the Virginia Department of Health, and is responsible for the cost-effectiveness analysis for this project.
Assume that the screenings will take place once a year. Evaluate the suggested intervention discussing the following key issues associated with the intervention:
a) The perspective of the study: Consider cost of obesity/eating disorder to theindividual with illness or to the society as a whole
b) The intervention time frame: The period should be sufficiently long to cover programstart-up phase and full program implementation (with ongoing costs and school schedule).
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 is not 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, whatare 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?
Outline the recommendations you would make? Support your analysis, evaluation, and recommendations through reference to the existing cost effectiveness literature.
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