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Epidemiology and Population Health

Screening and brief intervention for obesity in primary care: cost-effectiveness analysis in the BWeL trial

International Journal of Obesity volume 43, pages 2066–2075 (2019)Cite this article

Subjects

Abstract

Background

The Brief Intervention for Weight Loss Trial enrolled 1882 consecutively attending primary care patients who were obese and participants were randomised to physicians opportunistically endorsing, offering, and facilitating a referral to a weight loss programme (support) or recommending weight loss (advice). After one year, the support group lost 1.4 kg more (95%CI 0.9 to 2.0): 2.4 kg versus 1.0 kg. We use a cohort simulation to predict effects on disease incidence, quality of life, and healthcare costs over 20 years.

Methods

Randomly sampling from the trial population, we created a virtual cohort of 20 million adults and assigned baseline morbidity. We applied the weight loss observed in the trial and assumed weight regain over four years. Using epidemiological data, we assigned the incidence of 12 weight-related diseases depending on baseline disease status, age, gender, body mass index. From a healthcare perspective, we calculated the quality adjusted life years (QALYs) accruing and calculated the incremental difference between trial arms in costs expended in delivering the intervention and healthcare costs accruing. We discounted future costs and benefits at 1.5% over 20 years.

Results

Compared with advice, the support intervention reduced the cumulative incidence of weight-related disease by 722/100,000 people, 0.33% of all weight-related disease. The incremental cost of support over advice was £2.01million/100,000. However, the support intervention reduced health service costs by £5.86 million/100,000 leading to a net saving of £3.85 million/100,000. The support intervention produced 992 QALYs/100,000 people relative to advice.

Conclusions

A brief intervention in which physicians opportunistically endorse, offer, and facilitate a referral to a behavioural weight management service to patients with a BMI of at least 30 kg/m2 reduces healthcare costs and improves health more than advising weight loss.

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Acknowledgements

The trial was funded by the National Prevention Research Initiative of the UK, administered by the MRC. The funding partners are Alzheimer’s Research UK, Alzheimer’s Society, Biotechnology and Biological Sciences Research Council, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Scottish Government Health Directorate, Department of Health, Diabetes UK, Economic and Social Research Council, Engineering and Physical Sciences Research Council, Health and Social Care Research Division, Public Health Agency, Northern Ireland, Medical Research Council, Stroke Association, Wellcome Trust, Welsh Government, and World Cancer Research Fund. The weight loss programmes we used were provided by Slimming World and Rosemary Conley Health and Fitness Clubs. These are widely available through the English NHS at no cost to the patient and for which these organisations receive a fee. In this trial these 12-week programs were donated to the NHS by both these organisations and we are very grateful to them for this. Neither organisation had input into the protocol, the data analysis, or were involved in the decision to publish the findings. The investigators have no financial relationships with these companies. KJ is part-funded by the National Institute for Health Research (NIHR) and Collaboration for Leadership in Applied Health Research and Care (CLAHRC). Paul Aveyard and Susan Jebb are NIHR senior investigators and funded by the Oxford NIHR Biomedical Research Centre and CLAHRC. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health. SJ and PA are investigators on an investigator-initiated randomised trial of Cambridge Weight Plan and funded by a research grant to the University of Oxford. None of the investigators have received personal financial payments from any of these research relationships.

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Authors and Affiliations

  1. UK Health Forum, Fleetbank House, 2-6 Salisbury Square, London, EC4Y 8JX, UK

    Lise Retat, Laura Pimpin, Laura Webber & Abbygail Jaccard

  2. Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK

    Amanda Lewis & Kathryn Hood

  3. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK

    Sarah Tearne, Anna Christian-Brown, Rachna Begh, Alecia Nickless, Ly-Mee Yu, Susan Jebb & Paul Aveyard

  4. Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, UK

    Peymane Adab, Kate Jolly & Amanda Farley

  5. School of Sport, Exercise and Health Sciences, Loughborough University, Ashby Road, Loughborough, Leicestershire, LE11 3TU, UK

    Amanda Daley

  6. Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, UK

    Deborah Lycett

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Correspondence to Paul Aveyard.

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Retat, L., Pimpin, L., Webber, L. et al. Screening and brief intervention for obesity in primary care: cost-effectiveness analysis in the BWeL trial. Int J Obes 43, 2066–2075 (2019). https://doi.org/10.1038/s41366-018-0295-7

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