Cost-effectiveness of a primary care intervention to treat obesity.
BACKGROUND
Data on the cost-effectiveness of the behavioral treatment of obesity are not conclusive. The cost-effectiveness of treatment in primary care settings is particularly relevant.


METHODS
We conducted a within-trial cost-effectiveness analysis of a primary care-based obesity intervention. Study participants were randomized to: Usual Care (UC; quarterly visits with their primary care provider); Brief Lifestyle Counseling (BLC; quarterly provider visits plus monthly weight loss counseling visits) or Enhanced Brief Lifestyle Counseling (EBLC; all above interventions, plus choice of meal replacements or weight loss medication). A health-care payer perspective was used. Intervention costs were estimated from tracking data obtained prospectively. Quality-adjusted life years (QALYs) were estimated with the EuroQol-5D. We estimated cost per kilogram-year of weight loss and cost per QALY.


RESULTS
Weight losses after 2 years were 1.7, 2.9 and 4.6 kg for UC, BLC and EBLC, respectively (P=0.003 for comparison of EBLC vs UC). The incremental cost per kilogram-year lost was $292 for EBLC compared with UC (95% confidence interval (CI): $219-$437). The short-term incremental cost per QALY was $115,397, but the 95% CI were undefined. Comparison of short-term cost per kg with published estimates of longer-term cost per QALY suggested that the intervention could be cost-effective over the long term (≥ 10 years).


CONCLUSIONS
A primary care intervention that includes monthly counseling visits and a choice of meal replacements or weight loss medication could be a cost-effective treatment for obesity over the long term. However, additional studies are needed on the cost-effectiveness of behavioral treatment of obesity.
Division of General Internal Medicine, Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, CO 80045, USA. adam.tsai@ucdenver.edu
A G
AG
Tsai
T A
TA
Wadden
S
S
Volger
D B
DB
Sarwer
M
M
Vetter
S
S
Kumanyika
R I
RI
Berkowitz
L K
LK
Diewald
J
J
Perez
J
J
Lavenberg
E R
ER
Panigrahi
H A
HA
Glick
D003362:Cost-Benefit Analysis; D004038:Diet, Reducing / Q000191:economics*; D037001:Directive Counseling / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009765:Obesity / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D010414:Pennsylvania / Q000453:epidemiology; D011320:Primary Health Care / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D040242:Risk Reduction Behavior; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D015431:Weight Loss