title: Cost effectiveness of an internet-delivered lifestyle intervention in primary care patients with high cardiovascular risk.
abstract: To assess the cost-effectiveness of an online adaptation of the diabetes prevention program (ODPP) lifestyle intervention.
  
  
  
  ODPP was a before-after evaluation of a weight loss intervention comprising 16 weekly and 8 monthly lessons, incorporating behavioral tools and regular, brief, web-based individualized counseling in an overweight/obese cohort (mean age 52, 76% female, 92% white, 28% with diabetes). A Markov model was developed to estimate ODPP cost effectiveness compared with usual care (UC) to reduce metabolic risk over 10years. Intervention costs and weight change outcomes were obtained from the study; other model parameters were based on published reports. In the model, diabetes risk was a function of weight change with and without the intervention.
  
  
  
  Compared to UC, the ODPP in our cohort cost $14,351 and $29,331 per quality-adjusted life-year (QALY) gained from the health care system and societal perspectives, respectively. In a hypothetical cohort without diabetes, the ODPP cost $7777 and $18,263 per QALY gained, respectively. Results were robust in sensitivity analyses, but enrolling cohorts with lower annual risk of developing diabetes (≤1.8%), enrolling fewer participants (≤15), or increasing the hourly cost (≥$91.20) or annual per-participant time (≥1.45h) required for technical support could increase ODPP cost to >$20,000 per QALY gained. In probabilistic sensitivity analyses, ODPP was cost-effective in 20-58% of model iterations using an acceptability threshold of $20,000, 73-92% at $50,000, and 95-99% at $100,000 per QALY gained.
  
  
  
  The ODPP may offer an economical approach to combating overweight and obesity.
authors.affiliation: Section of Decision Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: smithkj2@upmc.edu.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.affiliation: Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.
authors.forename: Shihchen
authors.initials: S
authors.lastname: Kuo
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States; Center for Aging and Population Health Prevention Research Center, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Janice C
authors.initials: JC
authors.lastname: Zgibor
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States; Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: McTigue
authors.affiliation: Health System Innovation and Research Program, University of Utah, United States.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hess
authors.affiliation: College of Public Health, Kent State University, Kent, OH, United States.
authors.forename: Tina
authors.initials: T
authors.lastname: Bhargava
authors.affiliation: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Bryce
mesh_terms: D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D006293:Health Promotion; D006801:Humans; D006973:Hypertension; D020407:Internet; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D012307:Risk Factors
keywords: Cost effectiveness analysis; Diabetes mellitus; Health promotion