title: Economic evaluation of a weight control program with e-mail and telephone counseling among overweight employees: a randomized controlled trial.
abstract: BACKGROUND
  Distance lifestyle counseling for weight control is a promising public health intervention in the work setting. Information about the cost-effectiveness of such interventions is lacking, but necessary to make informed implementation decisions. The purpose of this study was to perform an economic evaluation of a six-month program with lifestyle counseling aimed at weight reduction in an overweight working population with a two-year time horizon from a societal perspective.
  
  
  METHODS
  A randomized controlled trial comparing a program with two modes of intervention delivery against self-help. 1386 Employees from seven companies participated (67% male, mean age 43 (SD 8.6) years, mean BMI 29.6 (SD 3.5) kg/m2). All groups received self-directed lifestyle brochures. The two intervention groups additionally received a workbook-based program with phone counseling (phone; n=462) or a web-based program with e-mail counseling (internet; n=464). Body weight was measured at baseline and 24 months after baseline. Quality of life (EuroQol-5D) was assessed at baseline, 6, 12, 18 and 24 months after baseline. Resource use was measured with six-monthly diaries and valued with Dutch standard costs. Missing data were multiply imputed. Uncertainty around differences in costs and incremental cost-effectiveness ratios was estimated by applying non-parametric bootstrapping techniques and graphically plotting the results in cost-effectiveness planes and cost-effectiveness acceptability curves.
  
  
  RESULTS
  At two years the incremental cost-effectiveness ratio was €1009/kg weight loss in the phone group and €16/kg weight loss in the internet group. The cost-utility analysis resulted in €245,243/quality adjusted life year (QALY) and €1337/QALY, respectively. The results from a complete-case analysis were slightly more favorable. However, there was considerable uncertainty around all outcomes.
  
  
  CONCLUSIONS
  Neither intervention mode was proven to be cost-effective compared to self-help.
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Marieke F
authors.initials: MF
authors.lastname: van Wier
authors.forename: J Caroline
authors.initials: JC
authors.lastname: Dekkers
authors.forename: Judith E
authors.initials: JE
authors.lastname: Bosmans
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.forename: Ingrid Jm
authors.initials: IJ
authors.lastname: Hendriksen
authors.forename: Nicolaas P
authors.initials: NP
authors.lastname: Pronk
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003376:Counseling / Q000379:methods*; D034742:Electronic Mail; D005260:Female; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D013689:Telephone; D061217:Weight Reduction Programs / Q000191:economics*