Comparing behavioral weight loss modalities: incremental cost-effectiveness of an internet-based versus an in-person condition.
The objective of this study was to assess the costs associated with a group behavioral weight loss intervention and compare cost-effectiveness based on treatment delivery modality (in-person vs. Internet). A randomized controlled trial examined efficacy of a group behavioral obesity intervention across in-person and Internet treatment modalities. Participants (N = 323, 93% women, mean BMI = 35.8) from two centers were randomized to treatment modality, and contact time was matched between conditions. Primary outcome was weight loss. Cost-effectiveness measures calculated life years gained (LYG) from changes in weight at 6 months, based on excess years of life lost (YLL) algorithm and the cost of the two modalities. In-person participants had significantly greater weight losses (-8.0 ± 6.1 kg) than Internet participants (-5.5 ± 5.6 kg), whereas differences in LYG were insignificant. Estimated LYG was 0.58 (95% confidence interval: 0.45, 0.71) and 0.47 (95% confidence interval: 0.34, 0.60) for the in-person and Internet condition, respectively. Total cost of conducting the in-person condition was $706 per person and the Internet condition was $372 per person with the difference mainly due to increased travel cost of $158 per person. The incremental cost-effectiveness ratio was $2,160 per (discounted) LYG for the Internet modality relative to no intervention/no weight loss and $7,177 per (discounted) LYG for the in-person modality relative to the Internet modality. Participant time costs are recognized as an important cost of medical and behavioral interventions. When participant time costs are included in an economic evaluation of a behavioral weight loss intervention, Internet-based weight loss delivery may be a more cost-effective approach to obesity treatment.
Fay W. Boozman College of Public Health, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA. RAKrukowski@uams.edu
Rebecca A
RA
Krukowski
J Mick
JM
Tilford
Jean
J
Harvey-Berino
Delia S
DS
West
D000328:Adult; D001521:Behavior Therapy / Q000191:economics*; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D015438:Health Behavior; D006801:Humans; D020407:Internet / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome; D015431:Weight Loss
J Med Internet Res. 2006 Jun 23;8(2):e10
16867965
JAMA. 2003 Jan 8;289(2):187-93
12517229
Int J Obes (Lond). 2006 Oct;30(10):1565-73
16552408
Obesity (Silver Spring). 2007 Jan;15(1):155-64
17228043
Ann Behav Med. 2009 Aug;38(1):40-5
19834778
Prev Med. 2009 Nov;49(5):390-5
19747937
JAMA. 1996 Oct 23-30;276(16):1339-41
8861994
Diabetes Care. 2007 Jun;30(6):1374-83
17363746
Arch Intern Med. 2006 Aug 14-28;166(15):1620-5
16908795
Prev Med. 2010 Aug;51(2):123-8
20478333
J Consult Clin Psychol. 2001 Aug;69(4):722-6
11550740
N Engl J Med. 2002 Feb 7;346(6):393-403
11832527
J Am Diet Assoc. 2004 Feb;104(2):226-32
14760571
Drug Alcohol Depend. 2010 Aug 1;110(3):200-7
20392575
Am J Manag Care. 2010 Apr 01;16(4):e98-104
20370312
Am J Med. 2002 Oct 15;113(6):491-8
12427499
J Clin Endocrinol Metab. 2004 Jun;89(6):2583-9
15181027
JAMA. 2006 Apr 5;295(13):1549-55
16595758
J Womens Health (Larchmt). 2006 May;15(4):379-89
16724886
Ann Behav Med. 2007 Feb;33(1):49-56
17291170
Obesity (Silver Spring). 2008 Oct;16(10):2323-30
18719634
Diabetes Care. 2003 Jan;26(1):36-47
12502656
BMC Health Serv Res. 2007 Dec 19;7:206
18093289