Case Study Analysis: Health Economics of BMI Screening Program

This case study analyzes the health economics of BMI screening programs in public schools, focusing on the increasing prevalence of childhood obesity. It explores the implementation of BMI and eating disorder (ED) screening programs, discussing their potential benefits, including early identification and treatment of obesity and disordered eating, and their associated costs, such as screening-related expenses, medical care, and non-health costs. The study presents tables with cost estimations, QALY calculations, and prevalence data, using secondary sources to conduct a cost-effectiveness analysis. It highlights the importance of early intervention to reduce the health and economic burden of obesity, and provides recommendations for governmental improvements to BMI screening programs. The analysis considers health equity, feasibility, stakeholder acceptability, and sustainability, ultimately evaluating the cost-effectiveness of BMI screening.

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Table of Contents
Introduction:...............................................................................................................................3
Literature:...................................................................................................................................3
Issues relating to the potential benefits (direct and indirect) and costs (direct and indirect).:...6
Table 1: Resources associated with Eating disorder screening and BMI screening in public
schools:...................................................................................................................................6
Table 2: The average cost of per person(Hypothetical estimates):........................................7
Table 3: Total cost related to screening of 200000 children..................................................7
Table 4: QALY’s Estimation.................................................................................................8
Table 5: Incremental costs, ICER and QALY’s.....................................................................8
Table 6: The lifetime prevalence of elevated BMI and prevalence of ED percentiles in U.S
children...................................................................................................................................9
Table 7: The hazard ratios of all‐cause mortality and standardized mortality rate of eating
disorders by BMI category...................................................................................................10
Analysis:...................................................................................................................................10
Conclusion and Recommendation:..........................................................................................13
References:...............................................................................................................................15
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Introduction:
The report will discuss the problem of increasing obesity issues among children across the
world. In the recent scenario, 28% o the children in Australia are suffering from Obesity and
day by day the number is increasing drastically. Overweight is another issues that stimulating
the obesity. In such condition it is very much important to produce a proper framework to
reduce the obesity in children. Early identification and treatment of the obesity issue can
reduce the risk of several chronic diseases and health consequences. Discussion will be done
on the early identification and treatment of weight control and disordered eating issues and
also how the early identification and treatment process prevents obesity progression amongst
the children and reduces the risk of several health issues. Moreover, it will discuss the
implementation of the BMI screening program in the school and the cost-effectiveness of the
program. How the state department of health is responsible to motivate every school to
implement the BMI screening program to early identify the obesity problem among the
children through measuring the BMI of the children. In addition, discussion will focus on
how the timely intervention of BMI screening helps to reduce the health and economic
burden of obesity among the children. The assignment will implement a cost-effective
analysis of the BMI screening program. In addition, it will provide future medical care tips to
prevent obesity and health-related issues and provides a recommendation to the government
of Australia to improve the BMI screening intervention program in the school of Australia.
Literature:
The article byForman et al., (2008), describes early identification and treatment of disordered
weight and how eating helps to control the behaviourof the children. It helps in preventing the
progression of health-related issues and reduces the risk of several chronic diseases and
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health consequences (Forman et al., 2008). In this article, national eating screening program
was first organized in the high schools across the United States. The national eating screening
program is held in the high school for identifying the eating disorder issues among the
children. The researchers found that 1 in 10 boys and 1 in 4 girls have 1 disorder weight or
eating control symptom (Eatingdisorders.org.au, 2019).
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Figure 1: Status of Obesity
(Source: www.nap.edu, 2019)
The researchers evaluated the disordered eatingandweightcontrol symptom by the health
professional to give them a warrant to improve the health condition. Researchers provide
them with a set of questionnaire and students of the school completed the self-report
careening questionnaires that include their eating attitude test, exercising to control weight,
vomiting issues, and binge eating. The questionnaires provided information about the
treatment of disordered eating. It is found that a large number of symptomatic students did
not take any treatment for an eating disorder. This research project provides a health strategy
to improve disordered eating issues and obesity issues among children (Forman et al., 2008).
This popular screening for weight control and an eating disorder in high school identify that
symptomatic students would benefit from the early popular screening intervention program. It
helps in preventing long term complication of obesity and disorder eating problem.
The Article byNihiseret al. (2009), focuses on main objective and background of the article
that the school-based BMI measurement system is a very effective approach. School-based
BMI measurement system has attracted the attention of the entire nation. This school-based
BMI measurement has a potential approach to reduces the issue of obesity among the youth
(Nihiser et al., 2009). The articles describe the effectiveness and impact of reducing the rate
of obesity, physical activity, and also provide information on the dietary that helps to
influences obesity. Researchers identify the number of concerns about the School-based
screening program that includes
1. Increasing dissatisfaction rate with the body image.
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2. The impact of the stigmatization which is already experienced by the obese youth.
3. The impact of harmful weight loss practices to control eating disorder.
4. Inappropriate response from the parents of the children.
5. The effect of the scare resources of health promotion.
6. Distract the youth from the other school-based prevention activities of obesity.
Researchers identify that BMI-surveillance programs are less effective because of the
program do not involve the follow-up care and communication with parents about sensitive
information (Nihiseret al. 2009).
The article by Stuhldreher et al. (2012), describes the cost of illness studies and cost-effective
analyses in eating disorder. The researchers identify the consequence of disordered eating
habit, increasing the rate of co morbidities frequently that includes osteopenia, osteoporosis,
renal problems, and cardiovascular problems (Stuhldreher et al. 2012). The researchers
identify that eating disorder issue associated with the many other psychiatric issues that
include personality disorder, major depressive disorder, anxiety disorder, and the main issue
is an obsessive-compulsive disorder. In addition, the researchers identify that eating disorder
issue associated with the high percentage risk of suicide. It means this issue increases the rate
of mortality (Stuhldreher et al. 2012). This eating disorder issue creates substantial costs.
Researchers evident that eating disorder probably reduces the economic issues or burden but
evaluation of indirect or direct costs shows that the costs arise due to the eating disorder.
The article by Wright et al. (2014), describes the cost-effectiveness of a school-based eating
disorder. The researchers found that the estimated cost of the cost-effectiveness of a school-
based eating disorder screening program is $9041 per life year with avoiding the eating
disorder and gained $56500 per QALY (Wright et al. 2014). The researcher founds that the
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school-based eating disorder screening program is cost-effective, relative and feasible. The
cost of a School-based eating disorder screening program is less than the other mental health
screening program. The school-based eating disorder screening program is more cost-
effective from other screening intervention that main target are adolescent females (Wright et
al., 2014).The school-based eating disorder screening program reduces the disparities among
female and male, overweight adolescents and minority issues.
Figure 2: Overweight among Children, Statistics
(Source: researcggate.net, 2019)
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Issues relating to the potential benefits (direct and indirect) and costs (direct and
indirect)
According to the case study, The Health economist of the state department of health is
implementing the BMI screening program in-state public school after the State premier
signed the bill. State department of health develops a plan for implementing the BMI and ED
screening with the Child Care National Association (Rodriguez, 2002). As per recent study it
has been observed that theoretical program following a review of existing and proposed
obesity and ED screening programs and ED screening instruments. The theoretical screening
program targeted a hypothetical cohort of 15.2 million 10- to 17-year-old males and females
enrolled in US public schools (Stuhldreher et al. 2012).
Table 1: Resources associated with Eating disorder screening and BMI screening in
public schools:
Screening-related Future medical care Non-health cost
1. Software or computer
for entering the data.
2. Staff training.
3. Stadiometers.
4. Time of staff to
conduct the entire
screening scales.
5. Post-screening
mailing cost.
(Yoo, 2016).
1. Treatment for co-
morbidities.
2. Medication care cost.
3. Co-payments cost.
4. Appointments with
mental health care,
sub-speciality, and
ancillary providers
(Mustelin et al.2016).
1. Production cost the
work or screening
program.
2. Wages(Yoo, 2016).
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Table 2: The average cost of per person (Hypothetical estimates):
Screening-related Medical Care Non-health Total societal
cost
Schools State
Government
Insurers
and/or
patients
patients
1 year
BMI screening
$300 $200 $300 $200 $1000
No screening
$0 $0 $400 $500 $900
BMI and ED
screening
$400 $400 $200 $200 $1200
5 year
BMI screening
$300 $300 $700 $800 $2100
No screening
$0 $0 $900 $900 $1800
BMI and ED
screening
$400 $400 $300 $500 $1600
(Source: Solmi et al. 2015)
Table 3: Total cost related to screening of 200000 children
Cost Areas Schools State government
BMI and ED screening $65,00,000 $65,00,000
BMI screening $45,00,000 $45,00,000
(Source: Solmi et al. 2015)
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Table 4: QALY’s Estimation
Length of evaluation Life expectancy QALY’s
1 year
BMI Screening
1 0.704
No screening 1 0.702
BMI and ED screening 1 0.705
5 year
BMI Screening
4.7 3.663
No screening 4.5 3.335
BMI and ED screening 5 3.714
(Source: Solmi et al.. 2015)
Table 5: Incremental costs, ICER and QALY’s
Length of
evaluation
Incremental
societal cost
Incremental
payers cost
Incremental
effectiveness(QALY’s)
ICER
perspective
of societal
ICER
perspective
of payers
1 year - - - - -
BMI
screening
300 500 0.003 100,000 205,000
No screening - - - - -
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BMI and ED
screening
200 500 0.006 30,000 125,000
5 years - - - - -
BMI
screening
-100 500 0.1616 -705 2728
NO
Screening
- - - - -
BMI and ED
Screening
-600 500 0.2784 -2346 2077
(Source: Solmi et al. 2015)
Table 6: The lifetime prevalence of elevated BMI and prevalence of ED percentiles in
U.S children
Lifetime prevalence by age groups, %(Standard Error)
Anorexia Bulimia Binge Eating Subthreshold Subthreshold
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Nervosa (AN) Nervosa (BN) Disorder AN BED
13 to14 y 0.2(0.11) 0.7(0.24) 1.5(0.36) 0.5(0.14) 2.3(0.43)
15 to 16 y 0.2(0.11) 0.8(0.19) 1.5(0.26) 0.8(0.18) 2.4(0.32)
17 to 18 y 0.2(0.11) 0.8(0.19) 1.8(0.36) 1.0(0.17) 2.4(0.44)
Prevalence of elevated BMI percentile by age group (years), % (95% confidence interval)
≥85th percentile
(overweight)
≥95th percentile
(obese)
≥97th percentile
(extremely obese)
6 to 11 y 33.1(27.0-36.6) 14.8(12.7- 17.0) 10.3(8.4-12.4)
12 to 19 y 33.6(27.0-36.6) 16.1(13.4- 19.1) 10.2(8.2-12.7)
(Source: Jiang et al. 2016)
Table 7: The hazard ratios of all‐cause mortality andstandardized mortality rate of
eating disorders by BMI category
hazard ratios of all‐cause mortality (95% confidence interval)
Normal weight(18.5 to less than 25) 1.1 (REF)
Obese( BMI from 30 to less than 35) 0.93(0.86-1.02)
Overweight(BMI from 25 to less than 30) 0.92(0.89-0.95)
Extremely obese (BMI greater than 35) 1.28(1.16-1.39)
(Source: Jiang et al. 2016)
the standardized mortality rate of eating disorders (95% confidence interval)
Bulimia Nervosa 1.83(1.43-2.58)
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Anorexia Nervosa 5.76(4.15-8.25)
Eating disorders, (including subthreshold
conditions and BED)
1.90(1.45-2.50)
(Source: Jiang et al. 2016)
Analysis:
Second Stage Filter Key Considerations
BMI Screening ED Screening
Health equity Yes, BMI screening impacts the
inequity of obesity (Graham et
al., 2018).
The BMI screening reduces and
prevents obesity among
children, correcting
misperception about children’s
weight among parents and
children.
School children are benefitted
by these screening programs.
Yes, ED screening creates an
impact on the distribution
inequity of an eating disorder.
The ED screening prevents
eating disorder’s long term
complication and prevents
children from chronic disease
and health consequences (Hsu
et al., 2015).
Feasibility of implementation BMI screening program is more
feasible for the schooling
environment. To implement the
BMI screening, Stadiometers,
Software or computer for
ED screening program is more
feasible and cost-effective
screening program for the
schooling environment (Hsu et
al., 2015). To implement the ED
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entering the data and BMI
screening instrument is
required. Proper training
program for staff must be
organized to implement BMI
screening (Graham et al., 2018).
screening, psychopathological
assessment instrument, Self-
report questionnairesare
required. Proper training
program for staff must be
organized to implement Ed
screening.
Acceptability to stakeholders School nurses, children, parents
of the children, adolescents,
health service providers, the
government participate in the
BMI Screening program in
school (Solmiet al. 2015).
school nurses, children, parents
of the children, adolescents,
health service providers, the
government participate in ED
Screening program in school
(Solmiet al. 2015).
Sustainability Department of Health is
responsible for screening the
BMI screening program in
school and the BMI screening
program takes place once in a
year. The state government
funded the BMI screening
program (Kass et al. 2017).
Department of Health is
responsible for screening the
ED screening program in school
and the ED screening program
takes place once in a year. The
state government funded the ED
screening program (Graham et
al. 2018).
Potential for unintended
consequences
The unintended consequences
of BMI screening include
Increasing dissatisfaction rate
The unintended consequences
of ED screening include the
effect of the scare resources of
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with the body image, the impact
of the stigmatization which is
already experienced by the
obese youth, the impact of
harmful weight loss practices
(Kasset al. 2017).
health promotion, Inappropriate
response from the parents of the
children (Hsu et al. 2015).
As per the study it has been observed that discount in future cost and benefit works in the
same way as the calculating compound is having its interest on the savings account. However
the difference is in interest rate that can have a large impact on compound savings over the
time, so there can be changes in Discount rates also. This is especially true for programs
where the majority of costs are realized in early years and are discounted only slightly, while
the majority of benefits are realized in later years and are discounted heavily
(Eatingdisorders.org.au. 2019).
Conclusion and Recommendation:
After analyzing the articles about the ED screening and BMI screening implementation
program in the schooling environment, it is concluded that early detection and treatment is
beneficial for the school students, it reduces the effects of potential harms, build a supportive
and safe environment for the school students of all type of body sizes. It will help in
implementing science-based strategies to promote healthy eating and physical activity. The
goal of the analysis is reducing and preventing the obesity issue among the children,
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correcting the misperception about children’s weight among the parents, motivates children
and their parents to make changes for a safe and healthy lifestyle, increases awareness among
the school administrator and staff by delivering messages about the importance of addressing
obesityissue (Solmi et al. 2015).Screening-related total cost for the screening of 200000
children, the average cost of per person(Hypothetical estimates), Incremental costs of ICER
and QALY’s are included in the calculation of screening the BMI and ED screening program
in school.
Quality of life for no screening is 0.702 for each of the 4.6 years.Quality of life for BMI
screening is multiplication between 0.704 for the first 2 years and 0.700 for the remaining 2.8
years. Quality of life for BMI and ED screening is multiplication between 0.705 for the first 2
years and 0.7 for the remaining 3 years (Anderson & Whitaker, 2009).
$200 for both medical care and non-health benefits in BMI and ED screening and $300 for
medical care and $200 for non-health benefits in BMI screening for 1 year added cost with
screening and treatments. The estimated ICER is 205,000 for BMI careening and 125,000
BMI and ED screening for 1Year (Solmiet al. 2015). From the perspective of the cost-
effective analysis, it is revealed that both BMI and ED screening program is less costly than
the other mental health screening programs, the evaluation of the program create effects on
the parents and children and increase their awareness about the positive impact of the BMI
and ED screening program.
After analyzation, it is recommended that the State government and State health department
must implement the ED and BMI screening program to reduce the obesity issues among the
children. The state government must organize a training program for school staffs that helps
in measuring the BMI of the children and creates a safe and healthy environment. The state
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health department must provide funds and deliver the proper instrument to implement the
BMI and ED screening program.
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References:
Eatingdisorders.org.au. (2019). Retrieved from https://www.eatingdisorders.org.au/key-
research-a-statisticshttps://www.eatingdisorders.org.au/key-research-a-statistics
Forman, S., Prokop, L. A., Keliher, A., & Jacobs, D. (2008). Screening High School Students
for Eating Disorders: Results of a National Initiative. Preventing Chronic Disease, 5, 4.
Graham, A. K., Trockel, M., Weisman, H., Fitzsimmons-Craft, E. E., Balantekin, K. N.,
Wilfley, D. E., & Taylor, C. B. (2018). A screening tool for detecting eating disorder risk
and diagnostic symptoms among college-age women. Journal of American College
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Joy, E., Kussman, A., &Nattiv, A. (2016). 2016 update on eating disorders in athletes: A
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Sports Med, 50(3), 154-162.
Anderson, S. E., & Whitaker, R. C. (2009). Prevalence of obesity among US preschool
children in different racial and ethnic groups. Archives of pediatrics & adolescent
medicine, 163(4), 344-348.
Rodriguez, M. A., Winkleby, M. A., Ahn, D., Sundquist, J., & Kraemer, H. C. (2002).
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Kass, A. E., Balantekin, K. N., Fitzsimmons‐Craft, E. E., Jacobi, C., Wilfley, D. E., &
Taylor, C. B. (2017). The economic case for digital interventions for eating disorders
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among United States college students. International Journal of Eating Disorders, 50(3),
250-258.
Murphy, A. J., White, M., Viani, K., & Mosby, T. T. (2016). Evaluation of the nutrition
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Mustelin, L., Kärkkäinen, U., Kaprio, J., &Keski-Rahkonen, A. (2016). The Eating Disorder
Inventory in the screening for DSM-5 binge eating disorder. Eating behaviors, 22, 145-
148.
Nihiser, A. J., Lee, S. M., Wechsler, H., McKenna, M., Odom, E., Reinold, C., ...
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