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Randomized Controlled Trial
. 2014 Aug;38(8):1104-9.
doi: 10.1038/ijo.2013.227. Epub 2013 Dec 4.

Cost Effectiveness of Primary Care Referral to a Commercial Provider for Weight Loss Treatment, Relative to Standard Care: A Modelled Lifetime Analysis

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Randomized Controlled Trial

Cost Effectiveness of Primary Care Referral to a Commercial Provider for Weight Loss Treatment, Relative to Standard Care: A Modelled Lifetime Analysis

N R Fuller et al. Int J Obes (Lond). .
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Abstract

Background: Because of the high prevalence of overweight and obesity, there is a need to identify cost-effective approaches for weight loss in primary care and community settings.

Objective: To evaluate the long-term cost effectiveness of a commercial weight loss programme (Weight Watchers) (CP) compared with standard care (SC), as defined by national guidelines.

Methods: A Markov model was developed to calculate the incremental cost-effectiveness ratio (ICER), expressed as the cost per quality-adjusted life year (QALY) over the lifetime. The probabilities and quality-of-life utilities of outcomes were extrapolated from trial data using estimates from the published literature. A health sector perspective was adopted.

Results: Over a patient's lifetime, the CP resulted in an incremental cost saving of AUD 70 per patient, and an incremental 0.03 QALYs gained per patient. As such, the CP was found to be the dominant treatment, being more effective and less costly than SC (95% confidence interval: dominant to 6225 per QALY). Despite the CP delaying the onset of diabetes by ∼10 months, there was no significant difference in the incidence of type 2 diabetes, with the CP achieving <0.1% fewer cases than SC over the lifetime.

Conclusion: The modelled results suggest that referral to community-based interventions may provide a highly cost-effective approach for those at high risk of weight-related comorbidities.

Figures

Figure 1
Figure 1
Health states included in the Markov model following a commercial programme versus standard care for weight loss treatment Circular arrows indicate that individuals can remain in this health state; BMI – Body Mass Index All individuals began the model in either an overweight BMI range, obese BMI range, or type 2 diabetes health state. The likelihood of moving from one state to another at the end of a cycle was governed by a series of annual probabilities. At the end of each cycle individuals could transition to a normal BMI range, overweight BMI range, obese BMI range, or a type 2 diabetes health state. However, it was assumed that no additional individuals would transition to a normal BMI range after the first 2-years post intervention. Once diagnosed with type 2 diabetes, individuals could remain living with the disease for the next cycle or die from type 2 diabetes. Individuals could die from non-diabetes related causes at any point in the model. All patients remained in the model until death or until they reached the age of 99 years.
Figure 2
Figure 2
Incremental cost effectiveness scatterplot of the commercial weight loss programme vs. standard care

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