Effects of lifestyle intervention on health care costs: Improving Control with Activity and Nutrition (ICAN).
OBJECTIVE
To evaluate program and health care costs of a lifestyle intervention in a high-risk obese population.


METHODS
Twelve-month randomized controlled trial comparing lifestyle case management to usual care.


METHODS
Health plan members (n=147) with obesity (body mass index >/=27) and type 2 diabetes.


METHODS
Lifestyle case management entailed individual and group education, support, and referrals by registered dietitians. Those in the usual-care group received educational material.


METHODS
Medical and pharmaceutical health care costs reimbursed by the participant's primary insurance company.


METHODS
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).


CONCLUSIONS
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.
Department of Public Health Sciences, 1710 Allied St, Suite 34, Charlottesville, VA 22903, USA. amw6n@virginia.edu
Anne M
AM
Wolf
Mir
M
Siadaty
Beverly
B
Yaeger
Mark R
MR
Conaway
Jayne Q
JQ
Crowther
Jerry L
JL
Nadler
Viktor E
VE
Bovbjerg
D015992:Body Mass Index; D019090:Case Management / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000628:therapy; D019317:Evidence-Based Medicine; D015444:Exercise / Q000502:physiology*; D005260:Female; D017048:Health Care Costs; D006266:Health Education / Q000379:methods; D006293:Health Promotion / Q000191:economics*; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D044623:Nutrition Therapy; D009747:Nutritional Physiological Phenomena; D052756:Nutritional Sciences / Q000193:education*; D009765:Obesity / Q000191:economics / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D013997:Time Factors; D014481:United States