title: Cost-utility analysis of a randomized controlled weight loss trial among lactating overweight/obese women.
abstract: BACKGROUND
  Overweight and obesity among young, adult women are increasing problems in Sweden as in many other countries. The postpartum period may be a good opportunity to improve eating habits and lose weight in a sustainable manner. The aim was to make a cost-utility analysis of a dietary behavior modification treatment alongside usual care, compared to usual care alone, among lactating overweight and obese women.
  
  
  METHODS
  This study was a cost-utility analysis based on a randomized controlled and longitudinal clinical diet intervention. Between 2007-2010, 68 women living in Sweden were, after baseline measurement at 8-12 weeks postpartum, randomly assigned to a 12-week dietary behavior modification treatment or control group. Inclusion criteria were: self-reported pre-pregnancy body mass index (BMI) 25-35 kg/m2, non-smoker, singleton term delivery, birth weight > 2500 g, intention to breastfeed for 6 mo and no diseases (mother and child). The women in the intervention group received 1.5 hour of individual counseling at study start and 1 hour at follow-up home visits after 6 weeks of intervention, with support through cell phone text messages every two wk. Dietary intervention aimed to reduce dietary intake by 500 kcal/day. The control group received usual care. Weight results have previously been reported. Here we report on analyses carried out during 2012-2013 of cost per quality adjusted life years (QALY), based on the changes in quality of life measured by EQ-5D-3 L and SF-6D. Likelihood of cost-effectiveness was calculated using Net Monetary Benefit method.
  
  
  RESULTS
  Based on conservative assumptions of no remaining effect after 1 year follow-up, the diet intervention was cost-effective. Costs per gained QALY were 8 643 - 9 758 USD. The likelihood for cost-effectiveness, considering a willingness to pay 50 000 USD for a QALY, was 87-93%.
  
  
  CONCLUSIONS
  The diet intervention is cost-effective.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT01343238 Registered April 27, 2011.The regional ethics committee in Gothenburg, Sweden, approved the study on November 15, 2006.
authors.affiliation: Centre for Health Care Science, Örebro University Hospital, Sweden and Örebro University, P,O,Box 1324, SE-701 13 Örebro, Sweden. lars.hagberg@orebroll.se.
authors.forename: Lars A
authors.initials: LA
authors.lastname: Hagberg
authors.forename: Hilde K
authors.initials: HK
authors.lastname: Brekke
authors.forename: Fredrik
authors.initials: F
authors.lastname: Bertz
authors.forename: Anna
authors.initials: A
authors.lastname: Winkvist
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007774:Lactation / Q000502:physiology*; D009765:Obesity / Q000178:diet therapy*; D049590:Postpartum Period; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013548:Sweden; D061217:Weight Reduction Programs / Q000191:economics* / Q000379:methods