OBJECTIVE: To evaluate program and health care costs of a lifestyle intervention in a high-risk obese population. DESIGN: Twelve-month randomized controlled trial comparing lifestyle case management to usual care. SUBJECTS/ SETTING:Health plan members (n=147) with obesity (body mass index >/=27) and type 2 diabetes. INTERVENTION: Lifestyle case management entailed individual and group education, support, and referrals by registered dietitians. Those in the usual-care group received educational material. MAIN OUTCOME MEASURES: Medical and pharmaceutical health care costs reimbursed by the participant's primary insurance company. STATISTICAL ANALYSIS: Total costs were modeled using the four-equation model using previous year cost as a predictor. RESULTS:Net cost of the intervention was $328 per person per year. After incorporating program costs, mean health plan costs were $3,586 (95% confidence interval [CI]: -$8,036, -$25, P<0.05) lower in case management compared to usual care. The difference was driven by group differences in medical (-$3,316, 95% CI: -$7,829 to -$320, P<0.05) but not pharmaceutical costs (-$239, 95% CI: -$870 to $280, not statistically significant), with fewer inpatient admissions and costs among case management compared with usual care (admission prevalence: 2.8% vs 22.5% respectively, P<0.001). CONCLUSION: Addition of a modest-cost, registered dietitian-led lifestyle case-management intervention to usual medical care did not increase health care costs and suggested modest cost savings among obese patients with type 2 diabetes. Larger trials are needed to determine whether these results can be replicated in a broader population. The findings can be judiciously applied to support that the addition of a registered dietitian-led lifestyle case-management program to medical care does not increase health care costs.
RCT Entities:
OBJECTIVE: To evaluate program and health care costs of a lifestyle intervention in a high-risk obese population. DESIGN: Twelve-month randomized controlled trial comparing lifestyle case management to usual care. SUBJECTS/ SETTING: Health plan members (n=147) with obesity (body mass index >/=27) and type 2 diabetes. INTERVENTION: Lifestyle case management entailed individual and group education, support, and referrals by registered dietitians. Those in the usual-care group received educational material. MAIN OUTCOME MEASURES: Medical and pharmaceutical health care costs reimbursed by the participant's primary insurance company. STATISTICAL ANALYSIS: Total costs were modeled using the four-equation model using previous year cost as a predictor. RESULTS: Net cost of the intervention was $328 per person per year. After incorporating program costs, mean health plan costs were $3,586 (95% confidence interval [CI]: -$8,036, -$25, P<0.05) lower in case management compared to usual care. The difference was driven by group differences in medical (-$3,316, 95% CI: -$7,829 to -$320, P<0.05) but not pharmaceutical costs (-$239, 95% CI: -$870 to $280, not statistically significant), with fewer inpatient admissions and costs among case management compared with usual care (admission prevalence: 2.8% vs 22.5% respectively, P<0.001). CONCLUSION: Addition of a modest-cost, registered dietitian-led lifestyle case-management intervention to usual medical care did not increase health care costs and suggested modest cost savings among obesepatients with type 2 diabetes. Larger trials are needed to determine whether these results can be replicated in a broader population. The findings can be judiciously applied to support that the addition of a registered dietitian-led lifestyle case-management program to medical care does not increase health care costs.
Authors: Roberto P Benzo; Chung-Chou H Chang; Max H Farrell; Robert Kaplan; Andrew Ries; Fernando J Martinez; Robert Wise; Barry Make; Frank Sciurba Journal: Respiration Date: 2010-03-16 Impact factor: 3.580
Authors: Anne M Wolf; Mir S Siadaty; Jayne Q Crowther; Jerry L Nadler; Douglas L Wagner; Stephen L Cavalieri; Kurtis S Elward; Viktor E Bovbjerg Journal: J Occup Environ Med Date: 2009-02 Impact factor: 2.162
Authors: A G Tsai; T A Wadden; S Volger; D B Sarwer; M Vetter; S Kumanyika; R I Berkowitz; L K Diewald; J Perez; J Lavenberg; E R Panigrahi; H A Glick Journal: Int J Obes (Lond) Date: 2013-08 Impact factor: 5.095
Authors: Mark A Espeland; Henry A Glick; Alain Bertoni; Frederick L Brancati; George A Bray; Jeanne M Clark; Jeffrey M Curtis; Caitlin Egan; Mary Evans; John P Foreyt; Siran Ghazarian; Edward W Gregg; Helen P Hazuda; James O Hill; Don Hire; Edward S Horton; Van S Hubbard; John M Jakicic; Robert W Jeffery; Karen C Johnson; Steven E Kahn; Tina Killean; Abbas E Kitabchi; William C Knowler; Andrea Kriska; Cora E Lewis; Marsha Miller; Maria G Montez; Anne Murillo; David M Nathan; Ebenezer Nyenwe; Jennifer Patricio; Anne L Peters; Xavier Pi-Sunyer; Henry Pownall; J Bruce Redmon; Julia Rushing; Donna H Ryan; Monika Safford; Adam G Tsai; Thomas A Wadden; Rena R Wing; Susan Z Yanovski; Ping Zhang Journal: Diabetes Care Date: 2014-09 Impact factor: 19.112