Research question: What are the most effective, cost-effective, affordable and implementable policy options to prevent obesity across a range of settings?
Research team: Rob Carter (Stream 1 Lead), Jaithri Ananthapavan, Jan Barendregt, Vicki Brown, Anita Lal, Ana-Maria Mantilla Herrera, Marj Moodie, Pam Nguyen, Anna Peeters, Gary Sacks, Lennert Veerman
Institutions: Deakin University, University of Queensland, The George Institute for Global Health
- ACE-Obesity Policy report: Cost-effectiveness analyses were undertaken of 16 obesity prevention policies across a range of sectors/settings. Results from the cost-effectiveness analyses are presented in a league table ranked by incremental cost-effectiveness ratios in order from the most to the least cost-effective interventions. The results are presented alongside a rigorous qualitative analysis of how the interventions perform against key policy considerations (strength of evidence, equity, acceptability, feasibility and sustainability). The available evidence was reviewed for a further 12 interventions, but economic modelling was not conducted for these interventions due to a lack of evidence to support the assumptions required for modelling.
- ACE-Obesity Policy model: The model, a proportional multi-state life table Markov model, is based on the previously developed ACE-Prevention model, but incorporates some notable improvements and additional features. These include the ability to quantify costs and health impacts by socio-economic position (SEP), an expanded analytic scope of health outcomes to include children and health-related quality of life outcomes attributable to BMI status, and the inclusion of physical activity and fruit and vegetable intake as risk factors for disease.
- Eleven of the sixteen interventions for which full economic evaluations were conducted, were assessed as being ‘dominant’ (i.e., the intervention resulted in both health gains and cost-savings). The remaining five interventions were cost-effective with incremental cost-effectiveness ratios below the commonly-used decision threshold of $50,000 per health adjusted life year gained.
- The top three interventions on the league table (increasing the price of alcohol through a uniform volumetric tax, a sugar sweetened beverage tax, and regulations to restrict television advertising of unhealthy foods), are all regulatory interventions. Importantly, however, there is currently limited evidence of the impact of these interventions on BMI outcomes, with all scoring ‘low’ in relation to the ‘strength of evidence’ criteria. Nevertheless, extensive uncertainty, threshold and scenario analyses showed that results were robust to changes in intervention-specific key input variables and assumptions. There was variation in how these interventions performed in terms of ‘acceptability’ and ‘feasibility’. However, once implemented, they were all assessed as being ‘sustainable’, particularly taking into account their regulatory nature.
- Two interventions (tax on sugar-sweetened beverages, and regulations to restrict television advertising of unhealthy foods), used the ACE-Obesity Policy SEP model. Both interventions were found to have a positive equity impact on health outcomes, with increased health gains in the lower SEP groups compared to the higher SEP groups.