group 3. Findings of the assessment 1: Evidence Mapping Table for MEND Study Details Study design Outcome measures Main findings Results Evidence Grading Include? Reason for exclusion Sacher PM et al, 2010 MEND Target group: Children aged 7-13 and their families (Children aged 8-12 years in RCT) RCT (n=116) MEND versus waiting list for MEND (Control) Attempts made to overcome lack of blinding Non validated used to Waist BMI, body composition, physical activity level, sedentary activities, fitness, and were assessed at baseline, 6 & 12 months Participation in the MEND Program was effective in reducing adiposity in children and effects were sustained 9 months after the intensive part of the intervention. Importantly, the program is one of the few paediatric obesity interventions which conforms to expert recommendations and is deliverable in a primary care setting. High-attendance rates suggest that families found this intensive community-based Subjects were 60% white and 40% s-e group. Participants in the intervention group had a reduced waist circumference z-score (-0.37; P < 0.0001) and BMI z-score P < 0.0001) at 6 months when compared to the controls. Significant differences were also observed in cardiovascular fitness, physical activity, sedentary behaviours, and self-esteem. Mean attendance for the +/- Note: Small study with limitations Yes Trial
assess activity level. Baseline similar apart from gender, more girls in intervention group. intervention acceptable. These results suggest that the MEND Program is a promising intervention to help address the rising obesity problem in children. Further larger RCT is ongoing to measure the effectiveness of the program when delivered on a larger scale using methods that will address the limitations of the current trial. MEND Program was 86%. At 12 months, children in the intervention group had reduced their waist and BMI z-scores by 0.47 (P < 0.0001) and 0.23 (P < 0.0001), respectively, and benefits in cardiovascular fitness, physical activity levels, and self-esteem were sustained. Note: Groups only compared at 6 months. Data collected at 12 months for intervention only. There was some attrition - 6 cases from the intervention group dropped out before the started. At 6 trial
Children aged 7-13 and families less deprived backgrounds. Analysis is for England - estimated ICER of £1,668.2 per QALY. The thesis points out: In the roll-out phase of MEND eligibility criteria changed from BMI ≥ 98th centile (as for the RCT) to BMI ≥ 91st centile, therefore coverage of MEND has been extended to overweight children without supporting evidence from an RCT. The rollout also differs from the RCT in that the qualifications of the staff were ‘diminished’ in order to make the programme average follow-up duration of 10 weeks (this is a relatively short period of time re: outcomes and was due to large amounts of missing data from the roll-out phase). The study concluded that children with particular characteristics experience a higher degree of the effectiveness of MEND 7-13 in reducing BMIs. These characteristics are: male, White ethnicity, high baseline BMI, and frequent attendance of the programme. For Asian children, the only significant predictor is having parents who trial
NEF Consulting 2010 MEND Target Children aged 7-13 and their families evaluation with an assessment using ‘Social Return on Investment’ principles. The analyses in this report are informed by a Randomised Control (RCT) conducted in 2005-07 (26 above), data from the subsequent roll-out to 16,000 children and new health and well-being outcomes Incremental ratio (ICER) that it represents a cost-effective use of healthcare resources. There are methodological weaknesses in the data used in this analysis (see refs 1 & 2) above and thus the assumptions made for the analysis about the expected change in BMI and other outcomes are questionable. considerably below the NICE threshold for cost-effectiveness of £20,000-£30,000 per QALY gained and compares favourably with other obesity interventions. Health and well-being combined value; £4,021.42-£5,534.12 per enrolled child. Average cost per child: £415,77
Based upon the appraisal strategy above a subjective judgement of the overall balance of economic evidence was made by the economic evidence sub-group and the following traffic light system of grading was used. Green I Green II Amber I Amber II Red I Red II Large frequency of good quality economic showing as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation Small frequency of good quality economic showing as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation Fair quality economic showing as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation Fair quality evidence however, showing mixed evidence of as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation Poor quality evidence showing was not as appraised by Drummond et al’s Checklist for a sound economic evaluation No