Authors' objectives:

"The aim of this review was to clarify the role of growth monitoring, including obesity, and to examine issues that might impact on the effectiveness and cost-effectiveness of such programmes. The objectives were to:

determine the detection rate, age at diagnosis and route to diagnosis of the target growth-related conditions in the UK population

determine the clinical effectiveness of growth monitoring in terms of the age of diagnosis and management/outcome of children

determine the diagnostic performance of growth monitoring strategies for the identification of growth related conditions

evaluate any evidence of human resource requirement of growth monitoring programmes

evaluate any evidence of attitudes of children, parents and health care professionals to growth monitoring

determine the likely cost-effectiveness of routine growth monitoring."

(from executive summary)

Authors' results and conclusions: Monitoring for stature-related disorders Thirty-one studies were included in the review. There were no controlled trials of the impact of growth monitoring and no studies of the diagnostic accuracy of different methods for growth monitoring. Analysis of the studies that presented a ,diagnostic yield- of growth monitoring suggested that one-off screening might identify between 1:545 and 1:1793 new cases of potentially treatable conditions. Economic modelling suggested that growth monitoring is associated with health improvements [incremental cost per quality-adjusted life-year (QALY) of 9500] and indicated that monitoring was cost-effective 100% of the time over the given distributions for a willingness to pay threshold of 30,000 per QALY. Monitoring for obesity Studies of obesity focused on the performance of body mass index against measures of body fat. A number of issues relating to human resources of growth monitoring were identified, but data on attitudes to growth monitoring were extremely sparse. Preliminary findings from economic modelling suggested that primary prevention may be the most cost-effective approach to obesity management, but the model incorporates a great deal of uncertainty.

Authors' recommendations: This review has indicated the potential utility and cost-effectiveness of growth monitoring in terms of increased detection of stature-related disorders. It has also pointed strongly to the need for further research. Implications for policy and practice Monitoring for stature-related disorders Growth monitoring does not currently meet all NSC criteria. However, it is questionable whether some of these criteria can be meaningfully applied to growth monitoring given that short stature is not a disease in itself, but is used as a marker for a range of pathologies and as an indicator of general health status. There is a need to consider the extent to which it is appropriate to evaluate growth monitoring against NSC criteria. Those considering implementing growth monitoring programmes may need to consider whether the potential for earlier detection of stature-related disorders outweighs the lack of information on other relevant NSC criteria. It may be useful to consider the potential benefits of growth monitoring in the context of overall child health and the potential to detect other important, treatable disorders. Monitoring for obesity Identification of effective interventions for the treatment of obesity is likely to be considered a prerequisite to any monitoring programme designed to identify individual overweight and obese children. Similarly, further long-term studies of the predictors of obesity-related co-morbidities in adulthood are warranted; at present it is unclear how the target population of any monitoring programme should be defined. There is a need to consider these issues, and also the lack of data on the benefits and harms of monitoring, before moving away from the current population-based approach to obesity monitoring.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1447

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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