Socioeconomic differences in the cost-effectiveness of a telephone-based intervention for obesity prevention in early childhood

This study investigated the cost-effectiveness of an early childhood obesity prevention intervention providing telephone and short message service (SMS) support to mothers of children aged 2-4 years by socioeconomic position (SEP). A model-based SEP-specific economic evaluation of the intervention was conducted. SEP-specific intervention costs and effects at age 5 years were derived from the trial data and applied to a cohort of 4- to 5-year-old Australian children. We used the validated EQ-EPOCH microsimulation model to predict SEP-specific body mass index (BMI) trajectories, quality-adjusted life years (QALYs) and health care costs until 17 years of age. Incremental cost-effectiveness ratios (ICERs) and acceptability curves were derived for each SEP group, using 2023 Australian dollars (AUD). From an Australian health payer perspective, the ICERs for the low-SEP group were 131 per BMI unit avoided and 6549 per QALY gained, compared to the high-SEP group at 1161 per BMI unit avoided and 41, 462 per QALY gained. Results were robust to sensitivity analyses varying the intervention effect size, intervention costs, healthcare costs, discount rate and disutility from overweight. The probability that the intervention was cost-effective at a willingness-to-pay threshold of 50, 000 per QALY gained was extremely high in the low-SEP group (99. 7%) and marginally cost-effective in the high-SEP group (49. 6%). A telephone and SMS intervention was more cost-effective in low-SEP groups compared with high-SEP groups. Prioritizing families from socioeconomically disadvantaged backgrounds for this intervention will reduce healthy weight inequalities in childhood.