title: A within-trial cost-effectiveness analysis of primary care referral to a commercial provider for weight loss treatment, relative to standard care--an international randomised controlled trial.
abstract: BACKGROUND
  Due to the high prevalence of overweight and obesity there is a need to identify cost-effective approaches for weight loss in primary care and community settings.
  
  
  OBJECTIVE
  We evaluated the cost effectiveness of two weight loss programmes of 1-year duration, either standard care (SC) as defined by national guidelines, or a commercial provider (Weight Watchers) (CP).
  
  
  METHODS
  This analysis was based on a randomised controlled trial of 772 adults (87% female; age 47.4±12.9 years; body mass index 31.4±2.6 kg m(-2)) recruited by health professionals in primary care in Australia, United Kingdom and Germany. Both a health sector and societal perspective were adopted to calculate the cost per kilogram of weight loss and the ICER, expressed as the cost per quality adjusted life year (QALY).
  
  
  RESULTS
  The cost per kilogram of weight loss was USD122, 90 and 180 for the CP in Australia, the United Kingdom and Germany, respectively. For SC the cost was USD138, 151 and 133, respectively. From a health-sector perspective, the ICER for the CP relative to SC was USD18 266, 12 100 and 40 933 for Australia, the United Kingdom and Germany, respectively. Corresponding societal ICER figures were USD31,663, 24,996 and 51,571.
  
  
  CONCLUSIONS
  The CP was a cost-effective approach from a health funder and societal perspective. Despite participants in the CP group attending two to three times more meetings than the SC group, the CP was still cost effective even including these added patient travel costs. This study indicates that it is cost effective for general practitioners (GPs) to refer overweight and obese patients to a CP, which may be better value than expending public funds on GP visits to manage this problem.
authors.affiliation: The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, Australia.
authors.forename: N R
authors.initials: NR
authors.lastname: Fuller
authors.forename: S
authors.initials: S
authors.lastname: Colagiuri
authors.forename: D
authors.initials: D
authors.lastname: Schofield
authors.forename: A D
authors.initials: AD
authors.lastname: Olson
authors.forename: R
authors.initials: R
authors.lastname: Shrestha
authors.forename: C
authors.initials: C
authors.lastname: Holzapfel
authors.forename: S B
authors.initials: SB
authors.lastname: Wolfenstetter
authors.forename: R
authors.initials: R
authors.lastname: Holle
authors.forename: A L
authors.initials: AL
authors.lastname: Ahern
authors.forename: H
authors.initials: H
authors.lastname: Hauner
authors.forename: S A
authors.initials: SA
authors.lastname: Jebb
authors.forename: I D
authors.initials: ID
authors.lastname: Caterson
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D004038:Diet, Reducing / Q000191:economics; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D010349:Patient Compliance; D017060:Patient Satisfaction; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000191:economics*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000191:economics