title: Five-year medical and pharmacy costs after a medically supervised intensive treatment program for obesity.
abstract: OBJECTIVE
  The financial impact of intensive medical interventions for weight loss has not been fully studied.
  
  
  METHODS
  A randomized pragmatic clinical trial.
  
  
  METHODS
  Seven primary care clinics and one research center in Louisiana.
  
  
  METHODS
  Severely obese individuals (body mass index 40-60 kg/m(2)) randomized to usual care (n = 190) or intensive medical management (n = 200). Forty-seven percent of participants completed year 2 follow-up and were included in the analyses.
  
  
  METHODS
  Physician-monitored intervention with recommendations for 12 weeks of liquid diet followed by 4 months of group behavioral therapy, structured diet, and option of pharmacotherapy, and an additional 16 months of maintenance strategies.
  
  
  METHODS
  Two-year preintervention and 5-year postintervention measures were computed from claims data and included (1) medical costs excluding pharmacy, (2) pharmacy costs only, (3) total medical and pharmacy costs, and (4) medical and pharmacy subcategory costs.
  
  
  METHODS
  Differential categories for preintervention and postintervention were created using total sample 75th percentiles. Chi-square tests were employed to compare the intervention groups both preintervention and postintervention with respect to the proportion of subjects above the 75th percentile for each of the cost categories.
  
  
  RESULTS
  Medical costs excluding pharmacy did not differ between groups. The intensive medical intervention group had a significantly smaller percentage of subjects above the 75th percentile for pharmacy costs only (p = .0125), and for antidiabetic agents (p = .0464), antihypertensives (p = .0075), and dyslipidemic subcategories (p = .0197).
  
  
  CONCLUSIONS
  An intensive medical intervention may reduce pharmaceutical expenditures in severely obese individuals. These results must be viewed with caution given the high attrition of study participants.
authors: Valerie H
authors: VH
authors: Myers
authors: Megan Apperson
authors: MA
authors: McVay
authors: Meghan M
authors: MM
authors: Brashear
authors: William D
authors: WD
authors: Johnson
authors: Alok K
authors: AK
authors: Gupta
authors: Phillip J
authors: PJ
authors: Brantley
authors: Donna H
authors: DH
authors: Ryan
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008145:Louisiana; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics* / Q000517:prevention & control*; D011320:Primary Health Care; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome
keywords: Extreme Obesity, Medical Intervention, Cost Effectiveness/Cost Analysis, Health Care Utilization, Prevention Research. Manuscript format: research; Health focus: weight control; Outcome measure: medical and pharmacy claims expenditures; Research purpose: financial analysis/weight control; Setting: primary care clinics; Strategy: health care use, policy change; Study design: randomized pragmatic clinical trial; Target population age: adults; Target population circumstances: severely obese individuals (40–60 kg/m2)