Background
Methods
Structure of the health economic model
Decision analytic part
Children | Adults | |||||
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EBRBs | behaviour | Relative risk on overweight/obesity | reference | behaviour | Relative risk on overweight/obesity | reference |
Water consumption | 1.1 glass of water per day difference | 1.33 | [12] | inconclusive literature | ||
Fruits and berries | inconclusive literature | 3.13 daily servings difference | 1.23Ɨ (overweight)1.25Ɨ (obesity) | [13] | ||
Vegetables | inconclusive literature | 3.13 daily servings difference | 1.19Ɨ (overweight)1.15Ɨ (obesity) | [13] | ||
Screen time | > 4 h per day | 2.00 | [14] | > 21 h per week | 1.38 | [15] |
Sweets | inconclusive literature | inconclusive literature | ||||
Sugar-sweetened beverages | > 1 sugary drink per day | 1.22Ɨ | [16] | > 1 soft drink per day | 1.30 | [17] |
Daily physical activity | < 60 min per day | 1.35 | [18] | < 5 days per week 30 min | 1.07Ɨ | [15] |
Breakfast pattern | daily breakfast taking | 3.03 (overweight); 2.13 (obesity) | [19] | daily breakfast taking | 1.19 | [20] |
Markov model
Main health economic outcome
Clinical data input
Epidemiological data
Belgium | Finland | Greece | Spain | ||
---|---|---|---|---|---|
Men | Overweight | 1.05 | 0.97 | 1.07 | 1.07 |
Obese | 1.12 | 1.03 | 1.30 | 1.30 | |
Women | Overweight | 1.24 | 1.04 | 1.33 | 1.33 |
Obese | 1.39 | 0.89 | 1.46 | 1.46 |
Transition probabilities
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Transition probabilities from the at risk state to disease states in the control group were derived from European databases and international publications [10, 25‐30]. The transition probabilities in the intervention group were adjusted for the change in weight status as a result from the Feel4Diabetes intervention. For instance, overweight and obese men have respectively 125 and 450% more risk to develop T2DM (Table 3) [31]. Missing data were imputed by calculating the diseases’ total incidence ratio between countries with Belgium as reference country.
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Transition probabilities to the death state: country-, gender- and age-specific all-cause mortality rates were derived from Eurostat, the World Health Organization and the Belgian mortality table [35‐37]. These rates were multiplied with the relative mortality risk for patients with diabetes, to obtain the mortality risk for the health state ‘diabetes’ (Table 3) [38]. Belgian cancer mortality rates were obtained from the Belgian Cancer Registry [39, 40]. Dutch data were used to estimate mortality in CHD and stroke [41] since Belgian data were not available. Missing data were imputed by calculating the diseases’ total mortality ratio between countries with Belgium as reference country.
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Transition probabilities from disease state (e.g. BC) to the follow-up disease state (e.g. BC1): the transition probability is 100% minus the transition probability to the death state.
All-cause mortality | CHD | Stroke | Diabetes | BC | CRC | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | < 50 | 50–59 | 60–69 | 70+ | < 55 | < 65 | 65+ | < 65 | 65+ | <60y | 60-74y | 75+ | < 50 | 50+ | < 45 | 45+ | |
At Risk Men | Overweight | 1.20 | 1.20 | 1.19 | 1.18 | 1.35 | 1.35 | 1.25 | 1.20 | 1.15 | 2.25 | 2.15 | 2.13 | – | – | 1.20 | 1.18 |
Obese | 1.55 | 1.54 | 1.52 | 1.50 | 2.00 | 2.00 | 1.70 | 1.50 | 1.38 | 5.50 | 5.14 | 5.05 | – | – | 1.40 | 1.36 | |
At Risk Women | Overweight | 1.15 | 1.15 | 1.14 | 1.14 | 1.35 | 1.35 | 1.25 | 1.20 | 1.15 | 2.30 | 2.20 | 2.17 | 1.00 | 1.12 | 1.08 | 1.07 |
Obese | 1.50 | 1.49 | 1.48 | 1.45 | 2.00 | 2.00 | 1.70 | 1.55 | 1.41 | 7.00 | 6.52 | 6.40 | 1.00 | 1.12 | 1.10 | 1.09 | |
Diabetic Men | 1.57 | 1.57 | 1.57 | 1.57 | 2.19 | 1.43 | 1.33 | 1.83 | 1.83 | – | – | – | 1.23 | 1.23 | 1.26 | 1.26 | |
Diabetic Women | 2.00 | 2.00 | 2.00 | 2.00 | 2.19 | 1.43 | 1.33 | 2.28 | 2.28 | – | – | – | 1.23 | 1.23 | 1.26 | 1.26 |
Utilities
Cost data input
Disease state costs
Intervention costs
School-based component | High Risk Family component | |
---|---|---|
Scientific Staff | · Time attributed to communication with schools, directors and teachers · Facilitation of the intervention (information distribution, feedback, problem-solving) · Delivery of intervention material· Delivering the teachers’ training session · Transportation costs | · Time attributed to communication with high-risk parents · Delivering the HRF group and individual sessions · Transportation costs |
Community Stakeholders and NGO’s | · Extra time spending due to the study · Extra incurred costs due to the study | |
High Risk Families | · Transportation cost to the counseling sessions · Time spending at the counseling session· Incurred costs related to a changing lifestyle (e.g. gym subscription, training equipment, weight scale) | |
Teachers | · Travel time to the training session· Transportation cost to the training session · Time spent at the training session· Time spent for the implementation of the intervention before and after school time · Incurred costs related to the implementation of the intervention. | |
Other | · Distribution cost and production cost of newsletters· Other intervention costs reported by the scientific staff (i.e. intervention material) | · Distribution, collection and analysis of the FINDRISC questionnaire· Costs related to the SMS intervention · Other intervention costs reported by the scientific staff (i.e. intervention material) |