P2B300: Cost Effectiveness and Implementation Science of Evidence-based Intervention for Children Affected by Obesity at Federally Qualified Health Centers in Fresno, California

Background: Children affected by obesity is a major public health threat in the United States, especially in children impacted by differences in social determinants of health. Recent recommendations from the American Academy of Pediatrics advocate for more intensive early clinical interventions to treat children with obesity. Nevertheless, barriers to access treatment remain due to limited availability, high cost, and lack of insurance coverage. This analysis will evaluate the cost and impact of the Study of Technology Accelerate Research (STAR) program at federally qualified health centers (FQHC) in Fresno, California, where an estimated 17.5% of children aged 2-11 years are affected by obesity. The STAR program is a clinically proven, cost-effective intervention that promotes healthy weight in children impacted by obesity and has undergone evaluation in a cluster-randomized trial and peer-reviewed publications.

Methods: The STAR intervention trial demonstrated prevention of excess weight gain compared to standard care. The program uses EPIC software decision support tools to notify health providers of pediatric patients affected by obesity and the next steps in management during well child visits. Parents additionally receive text messages to support their child’s behavior change and have access to online health resources. We estimated the cost and expected impact of the STAR intervention in FQHC in Fresno, CA by scaling the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) national action kit.

Results: The STAR intervention is projected to reach 48,779 children and prevent 5,512 cases of obesity over 10 years if implemented in health care settings in Fresno, CA. The intervention cost per child is projected as $119 and is expected to result in healthcare cost savings of $0.27 per dollar invested. This intervention has the potential to reduce health disparities in children affected by obesity when implemented in community-based primary care clinics. Cost-effectiveness analysis of programs is an important factor for implementation and expansion of evidenced-based interventions. These considerations can impact decision-making across multi-level healthcare systems and potential for funding. Barriers for implementation include limited technological and EPIC support in the clinical settings.

Conclusion: Obesity disparities in the pediatric population in Fresno, CA may be addressed by implementing and expanding the STAR program, a low cost, evidenced-based intervention to treat obesity. This will reduce risk for obesity-related morbidities, especially children from low socioeconomic backgrounds.