Early Childhood Sleep Intervention is More Cost-Effective for Lower Socioeconomic Groups

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An economic analysis of a clinical sleep intervention suggests it may provide a step toward improved health equity.

Sleep intervention for the prevention of obesity provides is more cost-effective for infants in low- and mid-socioeconomic positions (SEPs) compared to infants from greater socioeconomic groups, according to new findings.

In new economic evaluation data from a team of Australia and New Zealand investigators, infants from low and mid-SEPs were very likely to achieve cost-effective outcomes from a series of simple sleep intervention strategies provided to their patients. The findings support policy-level strategies to address health inequities given both positive economic and clinical outcomes.

Led by Dr. Anagha Killedar, a research fellow at the Menzies Center Health Policy & Economics at the University of Sydney, investigators sought to examine the cost-effectiveness of the Prevention of Overweight in Infancy (POI) trial sleep intervention delivered to parents of infants ≤2 years old, based on patient SEP groups. The POI trial showed that an intervention including parental sleeping arrangement and feeding pattern advice; settling technique guidance; partial sleep intervention; and modified sleep techniques for parents were associated with reduced body mass index (BMI) in infants as well as cost-effectiveness.

However, existing evidence regarding clinical and cost-effectiveness in childhood obesity intervention based on SEP groups is mixed.

“Socioeconomic inequality in the prevalence of childhood over- weight and obesity is a stubborn problem in many countries,” investigators wrote. “Recent national health surveys have shown that obesity prevalence among children in low socioeconomic areas is twice that in high socioeconomic areas in Australia and New Zealand. Furthermore, there is concern that these inequalities are increasing over time.”

Killedar and colleagues conducted the SEP-specific economic evaluation of the POI sleep intervention by deriving intervention costs and overall effects at patients through age 5 via the original trial data. They then applied the data to a population-representative cohort of 4898 Australian children aged 4-5 years old.

The team then simulated quality-adjusted life years and health care costs through age 17 in the cohort via a purpose-build SEP-specific model. Cost-effectiveness rations and acceptability curves were derived for each of low-, mid- and high-SEP groups.

Investigators observed that incremental cost-effectiveness ratios, in Australian dollars per quality-adjusted life year gained per patient, were smaller among low- and mid-SEP group infants: $23,010 and $18,206, respectively. Among high-SEP group infants, the ratio was $31,981 per life year gained. They additionally noted very strong cost-effective probabilities among the low- and mid-SEP groups (92% - 100%) compared to the high-SEP group (79%).

“The findings of this study bear important implications for decisions on how best to target the sleep intervention,” investigators wrote. “As the intervention is highly cost-effective in the low- and mid-SEP groups, and the needs of the low-SEP group are the highest (having the highest rates of overweight and obesity), an approach that targets the intervention to low-SEP groups would satisfy both efficiency and equity objectives. The decision-maker would not need to make any trade-offs between these goals.”

The team concluded their findings support evidence for policies that may address health inequities—noting that the observed correlation between cost-effectiveness of an early-childhood sleep intervention and SEP shows a “trade-off between efficiency and equity would not need to be made if choosing to target low-SEP groups.”

“To promote policy approaches that address inequities, ana- lyses such as these should be conducted routinely for candidate interventions,” investigators wrote. “Further work is needed in the reporting of intervention effect sizes by SEP, health care usage by SEP, and the collection of intervention resource use and SEP measures at an individual level to allow for routine stratified economic evaluations of interventions.”

The study, “Is the cost-effectiveness of an early-childhood sleep intervention to prevent obesity affected by socioeconomic position?,” was published online in Obesity.