title: Medicare's intensive behavioral therapy for obesity: an exploratory cost-effectiveness analysis.
abstract: BACKGROUND
  Medicare coverage recently was expanded to include intensive behavioral therapy for obese individuals in primary care settings.
  
  
  OBJECTIVE
  To examine the potential cost effectiveness of Medicare's intensive behavioral therapy for obesity, accounting for uncertainty in effectiveness and utilization.
  
  
  METHODS
  A Markov simulation model of type 2 diabetes was used to estimate long-term health benefits and healthcare system costs of intensive behavioral therapy for obesity in the Medicare population without diabetes relative to an alternative of usual care. Cohort statistics were based on the 2005-2008 National Health and Nutrition Examination Survey. Model parameters were derived from the literature. Analyses were conducted in 2014 and reported in 2012 U.S. dollars.
  
  
  RESULTS
  Based on assumptions for the maximal intervention effectiveness, intensive behavioral therapy is likely to be cost saving if costs per session equal the current reimbursement rate ($25.19) and will provide a cost-effectiveness ratio of $20,912 per quality-adjusted life-year if costs equal the rate for routine office visits. The intervention is less cost effective if it is less effective in primary care settings or if fewer intervention sessions are supplied by providers or used by participants.
  
  
  CONCLUSIONS
  If the effectiveness of the intervention is similar to lifestyle interventions tested in other settings and costs per session equal the current reimbursement rate, intensive behavioral therapy for obesity offers good value. However, intervention effectiveness and the pattern of implementation and utilization strongly influence cost effectiveness. Given uncertainty regarding these factors, additional data might be collected to validate the modeling results.
authors.affiliation: RTI International, Research Triangle Park, North Carolina. Electronic address: tjh@rti.org.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hoerger
authors.affiliation: RTI International, Research Triangle Park, North Carolina.
authors.forename: Wesley L
authors.initials: WL
authors.lastname: Crouse
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Zhuo
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Ann L
authors.initials: AL
authors.lastname: Albright
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
mesh_terms: D000368:Aged; D001521:Behavior Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D006278:Medicare / Q000191:economics*; D018803:Models, Economic; D009765:Obesity / Q000191:economics* / Q000628:therapy*; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D014481:United States