Methods for Estimating Implementation Costs and Cost-Effectiveness of the Family Check-up 4 Health to Reduce Pediatric Obesity

Although efficacious interventions that reduce pediatric obesity exist, they are frequently not adopted in community settings. The cost associated with implementing a new innovation is one of the primary reasons public health interventions are not implemented (Glasgow & Emmons, 2007). The purpose of this paper is to describe multiple methods for estimating the implementation costs and cost-effectiveness of Family Check-Up 4 Health (FCU4Health), a pediatric obesity prevention intervention implemented in primary care. These analyses are critical for decision making to support the sustained implementation of the program

Estimating implementation costs and cost-effectiveness requires careful collection of the costs associated with developing, implementing, and sustaining delivery of programs. Electronic cost capture methods (Ritzwoller et al., 2009) are being used to track installation and delivery costs of the FCU4Health throughout the project period. Clinical staff complete a facilitator activities checklist at each service encounter with a family. The checklist captures information about the staff involved in the delivery, the number of hours spent on each activity, the location of services, and other pertinent information. Electronic budgets prospectively separate costs associated with implementation from those specifically related to research (e.g., participant reimbursement, data analysis software), start-up (e.g., training, portable video cameras, tablet computers), and ongoing costs (e.g., consultation with developers, technical assistance, travel for home visitation). Electronic medical record data and Medicaid/healthplan data will be used to identify relevant health services utilization and associated costs.

Budget impact analysis (Sullivan et al., 2014) is being used to estimate the short-term costs of installing the FCU4Health and providing the program to 200 families (those in the intervention arm of the trial). Conducted from the perspective of the 3 primary care clinics where FCU4Health is being implemented, the budget impact analysis will include costs associated with training and technical assistance. This analysis will allow us to also create a template that can be used by other primary care settings to estimate the costs of adopting FCU4Health in their settings.

Cost-effectiveness analysis (CEA) is being used to determine whether FCU4Health is more cost-effective than usual care in the short-term. Effectiveness measures in the CEA will include BMI, body fat composition, and quality-adjusted life-years. The CEA will be conducted from multiple perspectives—provider, payor, family, and societal—and will also consider whether investing in FCU4Health is associated with a reduction in avoidable emergency room and hospitalization costs.