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Cost-effectiveness of a primary care intervention to treat obesity

International Journal of Obesity volume 37, pages S31–S37 (2013)Cite this article

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Abstract

Background:

Data on the cost-effectiveness of the behavioral treatment of obesity are not conclusive. The cost-effectiveness of treatment in primary care settings is particularly relevant.

Methods:

We conducted a within-trial cost-effectiveness analysis of a primary care-based obesity intervention. Study participants were randomized to: Usual Care (UC; quarterly visits with their primary care provider); Brief Lifestyle Counseling (BLC; quarterly provider visits plus monthly weight loss counseling visits) or Enhanced Brief Lifestyle Counseling (EBLC; all above interventions, plus choice of meal replacements or weight loss medication). A health-care payer perspective was used. Intervention costs were estimated from tracking data obtained prospectively. Quality-adjusted life years (QALYs) were estimated with the EuroQol-5D. We estimated cost per kilogram-year of weight loss and cost per QALY.

Results:

Weight losses after 2 years were 1.7, 2.9 and 4.6 kg for UC, BLC and EBLC, respectively (P=0.003 for comparison of EBLC vs UC). The incremental cost per kilogram-year lost was $292 for EBLC compared with UC (95% confidence interval (CI): $219–$437). The short-term incremental cost per QALY was $115 397, but the 95% CI were undefined. Comparison of short-term cost per kg with published estimates of longer-term cost per QALY suggested that the intervention could be cost-effective over the long term (⩾10 years).

Conclusions:

A primary care intervention that includes monthly counseling visits and a choice of meal replacements or weight loss medication could be a cost-effective treatment for obesity over the long term. However, additional studies are needed on the cost-effectiveness of behavioral treatment of obesity.

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Acknowledgements

This research was supported by grants from the National Heart, Lung and Blood Institute (U01-HL087072) and the National Institute of Diabetes and Digestive and Kidney Diseases (K24-DK065018).

This article is published as part of a supplement, sponsored by the Center for Weight and Eating Disorders—University of Pennsylvania.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, CO, USA

    A G Tsai

  2. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    T A Wadden, S Volger, D B Sarwer, M Vetter, L K Diewald, J Perez, J Lavenberg & E R Panigrahi

  3. Department of Psychology, Haverford College, Haverford, PA, USA

    T A Wadden

  4. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    S Kumanyika & H A Glick

  5. Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    R I Berkowitz

  6. Division of General Internal Medicine, Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    H A Glick

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  1. A G Tsai
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Corresponding author

Correspondence to A G Tsai.

Ethics declarations

Competing interests

AGT has received grant support from the American Heart Association (AHA), Agency for Healthcare Research and Quality (AHRQ) and American Academy of Family Physicians (AAFP) Foundation. TAW serves on the advisory boards of Novo Nordisk and Orexigen Therapeutics, which are developing weight loss medications, as well as of Alere and the Cardiometabolic Support Network, which provide behavioral weight loss programs. TAW has also served as a consultant for Boehringer Ingelheim, and has received grant support from the National Institutes of Health (NIH/NIDDK and NIH/NHLBI). DBS discloses that he has relationships with the following companies: Allergan, BariMD, BaroNova, Enteromedics and Galderma. DBS has also received grant support from the National Institutes of Health (NIH). HAG has received grant support from the National Institutes of Health (NIH/NHLBI). The remaining authors declare no conflict of interest.

Additional information

Members are listed in the Appendix.

Appendix

Appendix

POWER-UP Research Group: Investigators and Research Coordinators

Academic investigators at the Perelman School of Medicine at the University of Pennsylvania were Thomas A Wadden, PhD (principal investigator), David B Sarwer, PhD (co-principal investigator), Robert I Berkowitz, MD, Jesse Chittams, MS, Lisa Diewald, MS, RD, Shiriki Kumanyika, PhD, Renee Moore, PhD, Kathryn Schmitz, PhD, Adam G Tsai, MD, MSCE, Marion Vetter, MD and Sheri Volger, MS, RD.

Research coordinators at the University of Pennsylvania were Caroline H Moran, BA, Jeffrey Derbas, BS, Megan Dougherty, BS, Zahra Khan, BA, Jeffrey Lavenberg, MA, Eva Panigrahi, MA, Joanna Evans, BA, Ilana Schriftman, BA, Dana Tioxon, Victoria Webb, BA and Catherine Williams-Smith, BS.

POWER-UP Research Group: Participating Sites and Clinical Investigators

PennCare—Bala Cynwyd Medical Associates: Ronald Barg, MD, Nelima Kute, MD, David Lush, MD, Celeste Mruk, MD, Charles Orellana, MD and Gail Rudnitsky, MD (primary care providers); Angela Monroe (lifestyle coach); Lisa Anderson (practice administrator).

PennCare—Internal Medicine Associates of Delaware County: David E Eberly, MD, Albert H Fink Jr, MD, Kathleen Malone, CRNP, Peter B Nonack, MD, Daniel Soffer, MD, John N Thurman, MD and Marc J Wertheimer, MD (primary care providers); Barbara Jean Shovlin, Lanisha Johnson (lifestyle coaches); Jill Esrey (practice administrator).

PennCare—Internal Medicine Mayfair: Jeffrey Heit, MD, Barbara C Joebstl, MD and Oana Vlad, MD (primary care providers); Rose Schneider, Tammi Brandley (lifestyle coaches); Linda Jelinski (practice administrator).

Penn Presbyterian Medical Associates: Joel Griska, MD, Karen J Nichols, MD, Edward G Reis, MD, James W Shepard, MD and Doris Davis-Whitely, PA (primary care providers); Dana Tioxon (lifestyle coach); Charin Sturgis (practice administrator).

PennCare—University City Family Medicine: Katherine Fleming, CRNP, Dana B Greenblatt, MD, Lisa Schaffer, DO, Tamara Welch, MD and Melissa Rosato, MD (primary care providers); Eugonda Butts, Marta Ortiz, Marysa Nieves and Alethea White (lifestyle coach); Cassandra Bullard (practice administrator).

PennCare—West Chester Family Practice: Jennifer DiMedio, CRNP, Melanie Ice, DO, Brandt Loev, DO, John S Potts, DO and Christine Tressel, DO (primary care providers); Iris Perez, Penny Rancy and Dianne Rittenhouse (lifestyle coaches); Joanne Colligan (practice administrator).

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Tsai, A., Wadden, T., Volger, S. et al. Cost-effectiveness of a primary care intervention to treat obesity. Int J Obes 37 (Suppl 1), S31–S37 (2013). https://doi.org/10.1038/ijo.2013.94

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