BACKGROUND: Data on the cost-effectiveness of the behavioral treatment of obesity are not conclusive. The cost-effectiveness of treatment in primary care settings is particularly relevant. METHODS: We conducted a within-trial cost-effectiveness analysis of a primary care-based obesity intervention. Study participants were randomized to: Usual Care (UC; quarterly visits with their primary care provider); Brief Lifestyle Counseling (BLC; quarterly provider visits plus monthly weight loss counseling visits) or Enhanced Brief Lifestyle Counseling (EBLC; all above interventions, plus choice of meal replacements or weight loss medication). A health-care payer perspective was used. Intervention costs were estimated from tracking data obtained prospectively. Quality-adjusted life years (QALYs) were estimated with the EuroQol-5D. We estimated cost per kilogram-year of weight loss and cost per QALY. RESULTS:Weight losses after 2 years were 1.7, 2.9 and 4.6 kg for UC, BLC and EBLC, respectively (P=0.003 for comparison of EBLC vs UC). The incremental cost per kilogram-year lost was $292 for EBLC compared with UC (95% confidence interval (CI): $219-$437). The short-term incremental cost per QALY was $115,397, but the 95% CI were undefined. Comparison of short-term cost per kg with published estimates of longer-term cost per QALY suggested that the intervention could be cost-effective over the long term (≥ 10 years). CONCLUSIONS: A primary care intervention that includes monthly counseling visits and a choice of meal replacements or weight loss medication could be a cost-effective treatment for obesity over the long term. However, additional studies are needed on the cost-effectiveness of behavioral treatment of obesity.
RCT Entities:
BACKGROUND: Data on the cost-effectiveness of the behavioral treatment of obesity are not conclusive. The cost-effectiveness of treatment in primary care settings is particularly relevant. METHODS: We conducted a within-trial cost-effectiveness analysis of a primary care-based obesity intervention. Study participants were randomized to: Usual Care (UC; quarterly visits with their primary care provider); Brief Lifestyle Counseling (BLC; quarterly provider visits plus monthly weight loss counseling visits) or Enhanced Brief Lifestyle Counseling (EBLC; all above interventions, plus choice of meal replacements or weight loss medication). A health-care payer perspective was used. Intervention costs were estimated from tracking data obtained prospectively. Quality-adjusted life years (QALYs) were estimated with the EuroQol-5D. We estimated cost per kilogram-year of weight loss and cost per QALY. RESULTS: Weight losses after 2 years were 1.7, 2.9 and 4.6 kg for UC, BLC and EBLC, respectively (P=0.003 for comparison of EBLC vs UC). The incremental cost per kilogram-year lost was $292 for EBLC compared with UC (95% confidence interval (CI): $219-$437). The short-term incremental cost per QALY was $115,397, but the 95% CI were undefined. Comparison of short-term cost per kg with published estimates of longer-term cost per QALY suggested that the intervention could be cost-effective over the long term (≥ 10 years). CONCLUSIONS: A primary care intervention that includes monthly counseling visits and a choice of meal replacements or weight loss medication could be a cost-effective treatment for obesity over the long term. However, additional studies are needed on the cost-effectiveness of behavioral treatment of obesity.
Authors: Zhaoping Li; Margaret Maglione; Wenli Tu; Walter Mojica; David Arterburn; Lisa R Shugarman; Lara Hilton; Marika Suttorp; Vanessa Solomon; Paul G Shekelle; Sally C Morton Journal: Ann Intern Med Date: 2005-04-05 Impact factor: 25.391
Authors: A Avenell; J Broom; T J Brown; A Poobalan; L Aucott; S C Stearns; W C S Smith; R T Jung; M K Campbell; A M Grant Journal: Health Technol Assess Date: 2004-05 Impact factor: 4.014
Authors: Anne M Wolf; Mark R Conaway; Jayne Q Crowther; Kristen Y Hazen; Jerry L Nadler; Beverly Oneida; Viktor E Bovbjerg Journal: Diabetes Care Date: 2004-07 Impact factor: 19.112
Authors: David M Levine; Stella Savarimuthu; Allison Squires; Joseph Nicholson; Melanie Jay Journal: J Gen Intern Med Date: 2014-08-19 Impact factor: 5.128
Authors: Gail L Daumit; Ellen M Janssen; Gerald J Jerome; Arlene T Dalcin; Jeanne Charleston; Jeanne M Clark; Janelle W Coughlin; Hsin-Chieh Yeh; Edgar R Miller; Nowella Durkin; Thomas A Louis; Kevin D Frick; Nae-Yuh Wang; Lawrence J Appel Journal: Transl Behav Med Date: 2020-02-03 Impact factor: 3.046
Authors: Richard T Meenan; Scott P Stumbo; Micah T Yarborough; Michael C Leo; Bobbi Jo H Yarborough; Carla A Green Journal: Adm Policy Ment Health Date: 2016-07
Authors: Ellen M Janssen; Gerald J Jerome; Arlene T Dalcin; Joseph V Gennusa; Stacy Goldsholl; Kevin D Frick; Nae-Yuh Wang; Lawrence J Appel; Gail L Daumit Journal: Obesity (Silver Spring) Date: 2017-04-11 Impact factor: 5.002
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