Within-Trial Cost-Effectiveness of a Structured Lifestyle Intervention in Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Action for Health in Diabetes (Look AHEAD) Study
Ping Zhang, Karen M Atkinson, George A Bray, Haiying Chen, Jeanne M Clark, Mace Coday, Gareth R Dutton, Caitlin Egan, Mark A Espeland, Mary Evans, John P Foreyt, Frank L Greenway, Edward W Gregg, Helen P Hazuda, James O Hill, Edward S Horton, Van S Hubbard, Peter J Huckfeldt, Sharon D Jackson, John M Jakicic, Robert W Jeffery, Karen C Johnson, Steven E Kahn, Tina Killean, William C Knowler, Mary Korytkowski, Cora E Lewis, Nisa M Maruthur, Sara Michaels, Maria G Montez, David M Nathan, Jennifer Patricio, Anne Peters, Xavier Pi-Sunyer, Henry Pownall, Bruce Redmon, Julia T Rushing, Helmut Steinburg, Thomas A Wadden, Rena R Wing, Holly Wyatt, Susan Z Yanovski, Look AHEAD Research Group, Ping Zhang, Karen M Atkinson, George A Bray, Haiying Chen, Jeanne M Clark, Mace Coday, Gareth R Dutton, Caitlin Egan, Mark A Espeland, Mary Evans, John P Foreyt, Frank L Greenway, Edward W Gregg, Helen P Hazuda, James O Hill, Edward S Horton, Van S Hubbard, Peter J Huckfeldt, Sharon D Jackson, John M Jakicic, Robert W Jeffery, Karen C Johnson, Steven E Kahn, Tina Killean, William C Knowler, Mary Korytkowski, Cora E Lewis, Nisa M Maruthur, Sara Michaels, Maria G Montez, David M Nathan, Jennifer Patricio, Anne Peters, Xavier Pi-Sunyer, Henry Pownall, Bruce Redmon, Julia T Rushing, Helmut Steinburg, Thomas A Wadden, Rena R Wing, Holly Wyatt, Susan Z Yanovski, Look AHEAD Research Group
Abstract
Objective: To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study.
Research design and methods: Data were from 4,827 participants during their first 9 years of study participation from 2001 to 2012. Information on Health Utilities Index Mark 2 (HUI-2) and HUI-3, Short-Form 6D (SF-6D), and Feeling Thermometer (FT), cost of delivering the interventions, and health expenditures was collected during the study. CE was measured by incremental CE ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 U.S. dollars.
Results: Over the 9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.07 and 0.15, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT.
Conclusions: Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.
Trial registration: ClinicalTrials.gov NCT00017953.
© 2020 by the American Diabetes Association.
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Source: PubMed