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Clinical Studies and Practice

Cost effectiveness of primary care referral to a commercial provider for weight loss treatment, relative to standard care: a modelled lifetime analysis

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.

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Acknowledgements

We acknowledge the assistance of Crystal Lee who provided critical analysis of the draft manuscript; Kirsten Howard who reviewed the Markov model; and Catherine Keating for assistance with data acquisition.

Author contributions

NRF: acquisition of data, development of the Markov model, analysis and interpretation of data and writing of the manuscript; HC, SC and DS: development of the Markov model, interpretation of data, critical review and writing of the manuscript; SAJ and HH: study design and conception, obtained funding and critical review of the manuscript; IDC: study design and conception, obtained funding and writing the manuscript. All authors read and approved the final manuscript.

Trial Registration: This study is registered with the International Standard Register of Clinical Trials, ISRCTN 85485463.

Role of the Funding Source: This study was investigator initiated but funded by Weight Watchers International through a grant to the Medical Research Council (UK). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Correspondence to I D Caterson.

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Competing interests

NRF and IDC have received research grants for other clinical trials funded by Sanofi-Aventis, Allergan, Eli Lilly and Novo Nordisk. IDC was a board member for the SCOUT trial, is on the EXSCEL Operations Committee and has received payment for lectures from iNova Pharmaceuticals, Pfizer Australia and Servier Laboratories (Australia). SAJ has received research grants for other clinical trials from Sanofi-Aventis and Coca Cola, and is a member of the Tanita Medical Advisory Board and receives a fee for nutrition articles and lectures for Rosemary Conley Enterprises. HH is on the Advisory Board for Weight Watchers International and has received payment for lectures from Sara Lee, Novartis, Sanofi Aventis and Bristol-Myers Squibb.

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Fuller, N., Carter, H., Schofield, D. et al. Cost effectiveness of primary care referral to a commercial provider for weight loss treatment, relative to standard care: a modelled lifetime analysis. Int J Obes 38, 1104–1109 (2014). https://doi.org/10.1038/ijo.2013.227

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  • DOI: https://doi.org/10.1038/ijo.2013.227

Keywords

  • Markov model
  • overweight
  • type 2 diabetes

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