Costs of Preparing to Implement a Family-Based Intervention to Prevent Pediatric Obesity in Primary Care: a Budget Impact Analysis
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The costs associated with implementing evidence-based programs for pediatric obesity contribute to a lack of widespread adoption. This study examined the costs of preparing to implement the Family Check-Up 4 Health (FCU4Health), a family-centered behavioral program for the prevention of pediatric obesity and excess weight gain in primary care. Budget impact analysis was used to estimate the cost of preparing to implement FCU4Health (i.e., the activities to prepare for, but prior to, offering the service to families). Electronic cost capture methods were used to prospectively track personnel time associated with implementation preparation activities. We also estimated the cost of replicating these preparatory activities to inform future decisions to adopt the program and associated budgetary planning. The total cost of FCU4Health implementation preparation in three clinics and developing delivery materials and infrastructure was $181,768, for an average of $60,589 per clinic. Over two thirds of the total cost were personnel related, the largest of which was associated with the time spent developing automated fidelity coding for monitoring (20%), developing and tailoring clinical materials (16%), and training FCU4Health coordinators (15%). Due to these development costs associated with an initial implementation, that we anticipate would not be repeated in full, we estimated the cost to prepare FCU4Health for implementation in a future initiative will range from $15,195 to $17,912 per clinic. This study is a critical step towards equipping decision-makers with comprehensive short-term information about expected costs that are incurred immediately after choosing to adopt an evidence-based program.
KeywordsBudget impact analysis Family Check-Up 4 Health Implementation cost Health economics Primary care
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (U18 DP006255; Berkel & Smith), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (F32 HD089586; Graham).
Compliance with Ethical Standards
Conflict of Interest
JDS and CB co-developed the Family Check-Up 4 Health program with Thomas Dishion, the developer of the original Family Check-Up.
This trial was designed in accordance with the basic ethical principles of autonomy, beneficence, justice, and non-maleficence and will be conducted in accordance with the rules of Good Clinical Practice outlined in the most recent Declaration of Helsinki. Data confidentiality and anonymity will be ensured. The project was approved by the Institutional Review Boards of Arizona State University (Protocol 00004530) and the Phoenix Children’s Hospital (Protocol 17-001). All other institutions participating in this research provided signed reliance agreements ceding to the Institutional Review Board of Arizona State University. Any important protocol modification will be communicated to the Institutional Review Board of Arizona State University and updated in Clinicaltrials.gov.
Informed consent was not required for this aspect of the study as the data sources are administrative.
- August, G. P., Caprio, S., Fennoy, I., Freemark, M., Kaufman, F. R., Lustig, R. H., et al. (2008). Prevention and treatment of pediatric obesity: An endocrine society clinical practice guideline based on expert opinion. Journal of Clinical Endocrinology & Metabolism, 93, 4576–4599. https://doi.org/10.1210/jc.2007-2458.CrossRefGoogle Scholar
- Barlow, S. E. (2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics, 120(Supplement 4), S164–S192.Google Scholar
- Berkel, C., Rudo-Stern, J., Villamar, J. A., Wilson, C., Flanagan, E., Lokey, F., . . . Smith, J. D. (manuscript under review). Recommendations from community partners to promote sustainable implementation of evidence-based programs in primary care.Google Scholar
- Bureau of Labor Statistics (2016). Occupational Employment Statistics: May 2016 Occupation Profiles.Google Scholar
- Dishion, T. J., Shaw, D. S., Connell, A., Gardner, F. E. M., Weaver, C., & Wilson, M. (2008). The family check-up with high-risk indigent families: Preventing problem behavior by increasing parents’ positive behavior support in early childhood. Child Development, 79, 1395–1414. https://doi.org/10.1111/j.1467-8624.2008.01195.x.CrossRefPubMedPubMedCentralGoogle Scholar
- Hoelscher, D. M., Kirk, S., Ritchie, L., & Cunningham-Sabo, L. (2013). Position of the academy of nutrition and dietetics: Interventions for the prevention and treatment of pediatric overweight and obesity. Journal of the Academy of Nutrition and Dietetics, 113, 1375–1394. https://doi.org/10.1016/j.jand.2013.08.004.CrossRefPubMedGoogle Scholar
- Janicke, D. M., Steele, R. G., Gayes, L. A., Lim, C. S., Clifford, L. M., Schneider, E. M., et al. (2014). Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity. Journal of Pediatric Psychology. https://doi.org/10.1093/jpepsy/jsu023.
- Leslie, L. K., Mehus, C. J., Hawkins, J. D., Boat, T., McCabe, M., Barkin, S. L., . . . Beardslee, W. R. (2016). Primary health care: Potential home for family-focused preventive interventions. American Journal of Preventive Medicine, 51, S106–S118. doi: https://doi.org/10.1016/j.amepre.2016.05.014
- Metz, A., & Bartley, L. (2012). Active Implementation Frameworks for Program Success: How to Use Implementation Science to Improve Outcomes for Children. Zero to Three (J), 32(4), 11-18.Google Scholar
- McGovern, L., Johnson, J. N., Paulo, R., Hettinger, A., Singhal, V., Kamath, C., et al. (2008). Treatment of pediatric obesity: A systematic review and meta-analysis of randomized trials. Journal of Clinical Endocrinology & Metabolism, 93, 4600–4605. https://doi.org/10.1210/jc.2006-2409.CrossRefGoogle Scholar
- National Instututes of Health. (2015). Notice on salary limitation on grants, cooperative agreements, and contracts. Bethesda, MD Retrieved from https://grants.nih.gov/grants/guide/notice-files/NOT-OD-16-045.html.
- National Research Council and Institute of Medicine. (2011). Early childhood obesity prevention policies. Washington, DC: The National Academies Press.Google Scholar
- Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, C. D., Kruszon-Moran, D., Kit, B. K., & Flegal, K. M. (2016). Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA, 315, 2292–2299. https://doi.org/10.1001/jama.2016.6361.CrossRefPubMedPubMedCentralGoogle Scholar
- Raghavan, R. (2017). The role of economic evaluation in dissemination and implementation research. In R. Brownson, G. Colditz, & E. K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (2nd ed., pp. 89–106). New York, NY: Oxford University Press.Google Scholar
- Ritzwoller, D. P., Sukhanova, A., Gaglio, B., & Glasgow, R. E. (2009). Costing behavioral interventions: a practical guide to enhance translation. Annals of Behavioral Medicine, 37(2), 218–227.Google Scholar
- Saldana, L., Chamberlain, P., Bradford, W. D., Campbell, M., & Landsverk, J. (2014). The cost of implementing new strategies (COINS): A method for mapping implementation resources using the stages of implementation completion. Children and Youth Services Review, 39, 177–182. https://doi.org/10.1016/j.childyouth.2013.10.006.CrossRefPubMedGoogle Scholar
- Smith, J. D., Berkel, C., Jordan, N., Atkins, D. C., Narayanan, S. S., Gallo, C., et al. (2018). An individually tailored family-centered intervention for pediatric obesity in primary care: Study protocol of a randomized type II hybrid implementation-effectiveness trial (raising healthy children study). Implementation Science, 13, 1–15. https://doi.org/10.1186/s13012-017-0697-2.CrossRefGoogle Scholar
- Smith, J. D., Berkel, C., Rudo-Stern, J., Montaño, Z., St. George, S, M., Prado, G., . . . Dishion, T. J. (under review). The Family Check-Up 4 Health (FCU4Health): Applying implementation science frameworks to the process of adapting an evidence-based parenting program for prevention of pediatric obesity and excess weight gain in primary care Frontiers in Public Health.Google Scholar
- Smith, J. D., Montaño, Z., Dishion, T. J., Shaw, D. S., & Wilson, M. N. (2015). Preventing weight gain and obesity: Indirect effects of a family-based intervention in early childhood. Prevention Science, 16, 408–419. https://doi.org/10.1007/s11121-014-0505-z.CrossRefPubMedPubMedCentralGoogle Scholar
- Sullivan, S. D., Mauskopf, J. A., Augustovski, F., Jaime Caro, J., Lee, K. M., Minchin, M., . . . Shau, W.-Y. (2014). Budget impact analysis—principles of good practice: Report of the ISPOR 2012 budget impact analysis good practice II task force. Value in Health, 17, 5–14. doi: https://doi.org/10.1016/j.jval.2013.08.2291.CrossRefPubMedGoogle Scholar
- Van Ryzin, M. J., & Nowicka, P. (2013). Direct and indirect effects of a family-based intervention in early adolescence on parent−youth relationship quality, late adolescent health, and early adult obesity. Journal of Family Psychology, 27, 106–116. https://doi.org/10.1037/a0031428.CrossRefPubMedPubMedCentralGoogle Scholar