Assessing the Lifetime Cost-Effectiveness of Low-Protein Infant Formula as Early Obesity Prevention Strategy: The CHOP Randomized Trial

Abstract

Background: Although there is a growing number of early childhood obesity prevention programs, only a few of them are effective in the long run. Even fewer reports exist on lifetime cost-effectiveness of early prevention strategies. This paper aimed to assess the lifetime cost-effectiveness of infant feeding modification aiming at reducing risk of later obesity.

Methods: The simulation model consists of two parts: (a) Model I used data from the European Childhood Obesity Project (CHOP) trial (up to 6 years) and the German Interview and Examination Survey for Children (KiGGS) (6-17 years) to evaluate BMI trajectories of infants receiving either lower protein (LP) or higher protein (HP) content formula; and (b) Model II estimated lifetime cost-effectiveness based on Model I BMI trajectories. Compared to HP formula, LP formula feeding would incur lower costs that are attributable to childhood obesity across all decades of life.

Results: Our analysis showed that LP formula would be cost-effective in terms of a positive net monetary benefit (discounted 3%) as an obesity prevention strategy. For the 19% of infants fed with formula in Germany, the LP strategy would result in cost savings of € 2.5 billion.

Conclusions: Our study is one of the first efforts to provide much-needed cost-effectiveness evidence of infant feeding modification, thereby potentially motivating interventionists to reassess their resource allocation.

Keywords: childhood; cost-effectiveness; early nutrition; formula; markov model; obesity prevention.

Figure 1

Conceptual model assessing the cost-effectiveness of LP content formula compared to HP one. The simulation model consists of two parts: the childhood-to-adolescence model (M1) and the adulthood model (M2). Two base cohorts were created: children fed with LP formula and children fed with HP formula.

Figure 2

Total lifetime cost attributable to overweight and obesity occurring in different life decades, stratified by infant feeding strategy. Total lifetime cost attributable to overweight and obesity occurring in different life decades as well as partial costs directly attributable to childhood overweight and obesity, stratified depending on whether an infant was fed with LP or HP content formula.

Figure 3

Lifetime excess cost and benefits through childhood overweight and obesity, stratified by infant feeding strategy (lower protein (LP) or higher protein (HP)) based on Monte Carlo simulation, 4000 runs. Lifetime excess costs represents the additional costs of being overweight/obese in childhood compared to normal weight. Lifetime excess benefits are expressed as averted life years with overweight/ obesity.

Figure 4

Cost-effectiveness results (2015). Projected cost-effectiveness of LP versus HP content formula, 2015, lifetime QALYs per person, WTP = willingness to pay, NMB = net monetary benefit lifetime total (direct and indirect) costs per person, in parentheses 2.5 and 97.5 sensitivity bounds (Monte Carlo simulation), 4000 simulations, point estimate of NMB, calculated as (incremental QALYs*WTP) incremental costs, NMB for males: €750 (WTP = 0), €1048 (WTP = 1000), €2238 (WTP = 5000), NMB for females: €220 (WTP = 0), €401 (WTP = 1000), €1126 (WTP = 5000); estimated incremental cost–effectiveness ratio (ICER) (€/QALY): lifetime = –2521.10, late adolescence (<20 years) = –1705.92.