Cost-effectiveness and quality of life of a diet intervention postpartum: 2-year results from a randomized controlled trial

Lars Hagberg, Anna Winkvist, Hilde K Brekke, Fredrik Bertz, Else Hellebö Johansson, Ena Huseinovic, Lars Hagberg, Anna Winkvist, Hilde K Brekke, Fredrik Bertz, Else Hellebö Johansson, Ena Huseinovic

Abstract

Background: Pregnancy has been identified as a contributor to obesity. We have shown that a diet intervention postpartum produced a 2-y weight loss of 8%. Here, we present the impact of the diet intervention on cost-effectiveness and explore changes in quality of life (QOL).

Methods: A total of 110 postpartum women with overweight/obesity were randomly assigned to diet (D-group) or control (C-group). D-group received a 12-wk diet intervention within primary health care followed by monthly emails up to the 1-y follow-up. C-group received a brochure. Changes in QOL were measured using the 36-item Short Form Health Survey and EQ-5D. The analysis of cost-effectiveness was a cost-utility analysis with a health care perspective and included costs of intervention for stakeholder, quality-adjusted life-years (QALYs) gained and savings in health care. The likelihood of cost-effectiveness was examined using the net monetary benefit method.

Results: The D-group increased their QOL more than the C-group at 12 wk. and 1 y, with pronounced differences for the dimensions general health and mental health, and the mental component summary score (all p < 0.05). Cost per gained QALY was 1704-7889 USD. The likelihood for cost-effectiveness, based on a willingness to pay 50,000 USD per QALY, was 0.77-1.00.

Conclusions: A diet intervention that produced clinically relevant postpartum weight loss also resulted in increased QOL and was cost-effective.

Trial registration: Clinical trials, NCT01949558 , 2013-09-24.

Keywords: Cost-effectiveness; Postpartum; Primary health care; Quality of life; Weight loss.

Conflict of interest statement

Ethics approval and consent to participate

The trial was approved by the regional ethical committee in Gothenburg (Dnr 483–06 and Dnr 709–11) and written informed consent was obtained from all women.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of study participants in the LEVA in Real Life trial
Fig. 2
Fig. 2
Likelihood of cost-effectiveness when willingness to pay for a quality-adjusted life-year was 0–100,000 USD in the LEVA in Real Life trial. The analysis is based on the three quality of life-instruments Short-Form 6D (SF-6D), the EuroQol 5D (EQ-5D-3 L), and the EuroQol-VAS (EQ-VAS)

References

    1. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;3849945:766–781. doi: 10.1016/S0140-6736(14)60460-8.
    1. Sach TH, Barton GR, Doherty M, et al. The relationship between body mass index and health-related quality of life: comparing the EQ-5D, EuroQol VAS and SF-6D. Int J Obes (Lond) 2007;311:189–196. doi: 10.1038/sj.ijo.0803365.
    1. Soltoft F, Hammer M, Kragh N. The association of body mass index and health-related quality of life in the general population: data from the 2003 health survey of England. Qual Life Res. 1810;2009:1293–1299.
    1. Larsson U, Karlsson J, Sullivan M. Impact of overweight and obesity on health-related quality of life--a Swedish population study. Int J Obes Relat Metab Disord. 2002;263:417–424. doi: 10.1038/sj.ijo.0801919.
    1. Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011;3789793:815–825. doi: 10.1016/S0140-6736(11)60814-3.
    1. Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev. 2011;122:131–141. doi: 10.1111/j.1467-789X.2009.00712.x.
    1. Amorim Adegboye AR, Linne YM. Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database Syst Rev. 2013;7:CD005627.
    1. Cnattingius S, Villamor E. Weight change between successive pregnancies and risks of stillbirth and infant mortality: a nationwide cohort study. Lancet. 2016;10018:558–565. doi: 10.1016/S0140-6736(15)00990-3.
    1. Kirkegaard H, Stovring H, Rasmussen KM, et al. How do pregnancy-related weight changes and breastfeeding relate to maternal weight and BMI-adjusted waist circumference 7 y after delivery? Results from a path analysis. Am J Clin Nutr. 2014;992:312–319. doi: 10.3945/ajcn.113.067405.
    1. Rooney BL, Schauberger CW, Mathiason MA. Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstet Gynecol. 2005;1066:1349–1356. doi: 10.1097/01.AOG.0000185480.09068.4a.
    1. Butte NF, King JC. Energy requirements during pregnancy and lactation. Public Health Nutr. 2005;87A:1010–1027.
    1. Bastian LA, Pathiraja VC, Krause K, et al. Multiparity is associated with high motivation to change diet among overweight and obese postpartum women. Womens Health Issues. 2010;202:133–138. doi: 10.1016/j.whi.2009.11.005.
    1. Edvardsson K, Ivarsson A, Eurenius E, et al. Giving offspring a healthy start: parents’ experiences of health promotion and lifestyle change during pregnancy and early parenthood. BMC Public Health. 2011;11:936. doi: 10.1186/1471-2458-11-936.
    1. Executive summary: Guidelines (2013) for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society published by the Obesity Society and American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Based on a systematic review from the The Obesity Expert Panel, 2013. Obesity (Silver Spring, Md). 2014;22(Suppl 2):S5–39.
    1. Blissmer B, Riebe D, Dye G, et al. Health-related quality of life following a clinical weight loss intervention among overweight and obese adults: intervention and 24 month follow-up effects. Health Qual Life Outcomes. 2006;4:43. doi: 10.1186/1477-7525-4-43.
    1. Eriksson MK, Hagberg L, Lindholm L, et al. Quality of life and cost-effectiveness of a 3-year trial of lifestyle intervention in primary health care. Arch Intern Med. 2010;17016:1470–1479.
    1. Huseinovic E, Bertz F, Leu Agelii M, et al. Effectiveness of a weight loss intervention in postpartum women: results from a randomized controlled trial in primary health care. Am J Clin Nutr. 2016;1042:362–370. doi: 10.3945/ajcn.116.135673.
    1. Huseinovic E, Bertz F, Brekke HK, Winkvist A. Two-year follow-up of a postpartum weight loss intervention: results from a randomized controlled trial. Matern Child Nutr. 2017:e12539. 10.1111/mcn.12539.
    1. Nordic Nutrition Recommendations 2004 . Integrating nutrition and physical activity. Copenhagen: Nordic Council of Ministers; 2004.
    1. Bertz F, Winkvist A, Brekke HK. Sustainable weight loss among overweight and obese lactating women is achieved with an energy-reduced diet in line with dietary recommendations: results from the LEVA randomized controlled trial. J Acad Nutr Diet. 2015;1151:78–86. doi: 10.1016/j.jand.2014.05.017.
    1. Bosy-Westphal A, Later W, Hitze B, et al. Accuracy of bioelectrical impedance consumer devices for measurement of body composition in comparison to whole body magnetic resonance imaging and dual X-ray absorptiometry. Obes Facts. 2008;16:319–324. doi: 10.1159/000176061.
    1. Sullivan M, Karlsson J, Ware JE., Jr The Swedish SF-36 health survey--I. evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995;4110:1349–1358. doi: 10.1016/0277-9536(95)00125-Q.
    1. Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ. 2002;212:271–292. doi: 10.1016/S0167-6296(01)00130-8.
    1. Kharroubi S, Brazier JE, O’Hagan A. Modelling covariates for the SF-6D standard gamble health state preference data using a nonparametric Bayesian method. Soc Sci Med. 2007;646:1242–1252. doi: 10.1016/j.socscimed.2006.10.040.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol group. Ann Med. 2001;335:337–343. doi: 10.3109/07853890109002087.
    1. Dolan P, Gudex C, Kind P, Williams A. A social tariff for EuroQol: results from a UK general population survey. York: Centre for Health Economics, University of York; 1995. pp. 1–24.
    1. Statistics Sweden . Consumer price index for Sweden. Stockholm: Statistics Sweden; 2017.
    1. Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Mak. 1998;182(Suppl):S68–S80. doi: 10.1177/0272989X98018002S09.
    1. Shiroiwa T, Sung YK, Fukuda T, et al. International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness? Health Econ. 2010;194:422–437. doi: 10.1002/hec.1481.
    1. van Hout BA, Al MJ, Gordon GS, Rutten FF. Costs, effects and C/E-ratios alongside a clinical trial. Health Econ. 1994;35:309–319. doi: 10.1002/hec.4730030505.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2. Hillsdale: Lawrence Earlbaum Associates; 1988.
    1. Hayes M, Baxter H, Muller-Nordhorn J, Hohls JK, Muckelbauer R. The longitudinal association between weight change and health-related quality of life in adults and children: a systematic review. Obes Rev. 1812;2017:1398–1411.
    1. Ackermann RT, Edelstein SL, Narayan KM, et al. Changes in health state utilities with changes in body mass in the diabetes prevention program. Obesity (Silver Spring, Md) 2009;1712:2176–2181. doi: 10.1038/oby.2009.114.
    1. Williamson DA, Rejeski J, Lang W, et al. Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes. Arch Intern Med. 2009;1692:163–171. doi: 10.1001/archinternmed.2008.544.
    1. Martin CK, Church TS, Thompson AM, Earnest CP, Blair SN. Exercise dose and quality of life: a randomized controlled trial. Arch Intern Med. 2009;1693:269–278. doi: 10.1001/archinternmed.2008.545.
    1. Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ. 2016;9412:925–930. doi: 10.2471/BLT.15.164418.
    1. Claxton K. The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J Health Econ. 1999;183:341–364. doi: 10.1016/S0167-6296(98)00039-3.
    1. Bertz F, Brekke HK, Ellegard L, et al. Diet and exercise weight-loss trial in lactating overweight and obese women. Am J Clin Nutr. 2012;964:698–705. doi: 10.3945/ajcn.112.040196.
    1. Hagberg LA, Brekke HK, Bertz F, Winkvist A. Cost-utility analysis of a randomized controlled weight loss trial among lactating overweight/obese women. BMC Public Health. 2014;14:38. doi: 10.1186/1471-2458-14-38.
    1. Loveman E, Frampton GK, Shepherd J, et al. The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. Health Technol Assess. 2011;152:1–182.
    1. Franz MJ, VanWormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;10710:1755–1767. doi: 10.1016/j.jada.2007.07.017.
    1. Holzapfel C, Cresswell L, Ahern AL, et al. The challenge of a 2-year follow-up after intervention for weight loss in primary care. Int J Obes. 2014;386:806–811. doi: 10.1038/ijo.2013.180.
    1. Lim S, O'Reilly S, Behrens H, et al. Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis. Obes Rev. 2015;1611:972–987. doi: 10.1111/obr.12312.
    1. de Souza RJ, Eisen RB, Perera S, et al. Best (but oft-forgotten) practices: sensitivity analyses in randomized controlled trials. Am J Clin Nutr. 2016;1031:5–17. doi: 10.3945/ajcn.115.121848.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera