Long-term cost-effectiveness of weight management in primary care.
BACKGROUND
As obesity prevalence and health-care costs increase, Health Care providers must prevent and manage obesity cost-effectively.


METHODS
Using the 2006 NICE obesity health economic model, a primary care weight management programme (Counterweight) was analysed, evaluating costs and outcomes associated with weight gain for three obesity-related conditions (type 2 diabetes, coronary heart disease, colon cancer). Sensitivity analyses examined different scenarios of weight loss and background (untreated) weight gain.


RESULTS
Mean weight changes in Counterweight attenders was -3 kg and -2.3 kg at 12 and 24 months, both 4 kg below the expected 1 kg/year background weight gain. Counterweight delivery cost was pound59.83 per patient entered. Even assuming drop-outs/non-attenders at 12 months (55%) lost no weight and gained at the background rate, Counterweight was 'dominant' (cost-saving) under 'base-case scenario', where 12-month achieved weight loss was entirely regained over the next 2 years, returning to the expected background weight gain of 1 kg/year. Quality-adjusted Life-Year cost was pound2017 where background weight gain was limited to 0.5 kg/year, and pound2651 at 0.3 kg/year. Under a 'best-case scenario', where weights of 12-month-attenders were assumed thereafter to rise at the background rate, 4 kg below non-intervention trajectory (very close to the observed weight change), Counterweight remained 'dominant' with background weight gains 1 kg, 0.5 kg or 0.3 kg/year.


CONCLUSIONS
Weight management for obesity in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare resources use could offset the total cost of providing the Counterweight Programme, as well as bringing multiple health and Quality of Life benefits.
Trueman
P
P
York Health Economics Consortium Ltd., University of York, UK.
Haynes
S M
SM
Felicity Lyons
G
G
Louise McCombie
E
E
McQuigg
M S A
MS
Mongia
S
S
Noble
P A
PA
Quinn
M F
MF
Ross
H M
HM
Thompson
F
F
Broom
J I
JI
Laws
R A
RA
Reckless
J P D
JP
Kumar
S
S
Lean
M E J
ME
Frost
G S
GS
Finer
N
N
Haslam
D W
DW
Morrison
D
D
Sloan
B
B
D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D003110:Colonic Neoplasms / Q000150:complications* / Q000191:economics; D003327:Coronary Disease / Q000150:complications* / Q000191:economics; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000191:economics / Q000628:therapy*; D011320:Primary Health Care; D019057:Quality-Adjusted Life Years