Is Doctor Referral to a Low‐Energy Total Diet Replacement Program Cost‐Effective for the Routine Treatment of Obesity?
Open accessAbstract
Objective: The study objective was to estimate the cost‐effectiveness of a commercially provided low‐energy total diet replacement (TDR) program compared with nurse‐led behavioral support. Methods: A multistate life table model and the weight reduction observed in a randomized controlled trial were used to evaluate the quality‐adjusted life‐years and direct health care costs (in United Kingdom 2017 prices) over a lifetime with TDR versus nurse‐led support in adults who had obesity, assuming that (i) weight returns to baseline over 5 years and (ii) a 1‐kg weight loss is maintained after 5 years following TDR. Results: The per‐person costs of the TDR and nurse‐led programs were £796 and £34, respectively. The incremental cost‐effectiveness ratio of TDR was £12,955 (95% CI: £8,082‐£17,827) assuming that all weight lost is regained and £3,203 (£2,580‐£3,825) assuming that a 1‐kg weight loss is maintained after 5 years. TDR was estimated to be more cost‐effective (i.e., lower incremental cost‐effectiveness ratios) in older adults and those with a higher BMI, with little difference by gender. Conclusions: At current retail prices and with plausible long‐term weight regain trajectories, TDR is projected to be cost‐effective in adults with obesity and could be considered as an option to treat obesity in routine health care settings.
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In the DROPLET trial among people without diabetes, in routine practice, a total diet replacement programme (formula diets) with behavioural support proved more cost-effective than nurse-led dietary advice for long-term prevention of obesity-related diseases.
“In the Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET) trial among people without diabetes, in routine practice, a total diet replacement programme (formula diets) with behavioural support proved more cost-effective than nurse-led dietary advice for long-term prevention of obesity-related diseases [62].”
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Cites
Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., Mullany, E. C., Biryukov, S., Abbafati, C., Abera, S. F., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60460-8 · Cited by 11,952 · see citing works
Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
Sjöström, L., Lindroos, A.-K., Peltonen, M., Torgerson, J., Bouchard, C., Carlsson, B., Dahlgren, S., Larsson, B., Narbro, K., Sjöström, C. D., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa035622 · Cited by 4,457 · see citing works
Guh, D. P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C. L., & Anis, A. H. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-88 · Cited by 3,855 · see citing works
Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)33102-1 · Cited by 2,095 · cited 3× · see citing works
“Third, excess weight has been associated with increased incidence and costs of many health conditions not included in PRIMEtime, including knee osteoarthritis (2,34), and weight loss can promote diabetes remission, which is not included in the model (13,35).”
BackgroundMethodSjöström, L. (2013) · Journal of Internal Medicine · doi:10.1111/joim.12012 · Cited by 1,835 · see citing works
Bariatric Surgery and Long-term Cardiovascular Events
Sjöström, L., Peltonen, M., Jacobson, P., Sjöström, C. D., Karason, K., Wedel, H., Ahlin, S., Anveden, Å., Bengtsson, C., Bergmark, G., et al. (2012) · JAMA · doi:10.1001/jama.2011.1914 · Cited by 1,656 · see citing works
(2015) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(15)00291-0 · Cited by 1,029 · see citing works
Khera, R., Murad, M. H., Chandar, A. K., Dulai, P. S., Wang, Z., Prokop, L. J., Loomba, R., Camilleri, M., & Singh, S. (2016) · JAMA · doi:10.1001/jama.2016.7602 · Cited by 865 · see citing works
Dombrowski, S. U., Knittle, K., Avenell, A., Araujo-Soares, V., & Sniehotta, F. F. (2014) · BMJ · doi:10.1136/bmj.g2646 · Cited by 816 · see citing works
Schellenberg, E. S., Dryden, D. M., Vandermeer, B., Ha, C., & Korownyk, C. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-159-8-201310150-00007 · Cited by 520 · see citing works
Ma, C., Avenell, A., Bolland, M., Hudson, J., Stewart, F., Robertson, C., Sharma, P., Fraser, C., & MacLennan, G. (2017) · BMJ · doi:10.1136/bmj.j4849 · Cited by 464 · see citing works
The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention
The Diabetes Prevention Program Research Group (2012) · Diabetes Care · doi:10.2337/dc11-1468 · Cited by 436 · see citing works
Catalogue of EQ-5D Scores for the United Kingdom
Sullivan, P. W., Slejko, J. F., Sculpher, M. J., & Ghushchyan, V. H. (2011) · Medical Decision Making · doi:10.1177/0272989x11401031 · Cited by 364 · see citing works
Loveman, E., Frampton, G., Shepherd, J., Picot, J., Cooper, K., Bryant, J., Welch, K., & Clegg, A. (2011) · Health Technology Assessment · doi:10.3310/hta15020 · Cited by 296 · see citing works
Kwok, C. S., Pradhan, A. K., Khan, M. A., Anderson, S. G., Keavney, B. D., Myint, P. K., Mamas, M. A., & Loke, Y. K. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.02.026 · Cited by 265 · see citing works
Zomer, E., Gurusamy, K., Leach, R., Trimmer, C., Lobstein, T., Morris, S., James, W. P. T., & Finer, N. (2016) · Obesity Reviews · doi:10.1111/obr.12433 · Cited by 236 · see citing works
Categorical versus continuous risk factors and the calculation of potential impact fractions
Barendregt, J. J., & Veerman, L. J. (2009) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2009.090274 · Cited by 224 · see citing works
Ahern, A. L., Wheeler, G. M., Aveyard, P., Boyland, E. J., Halford, J. C. G., Mander, A. P., Woolston, J., Thomson, A. M., Tsiountsioura, M., Cole, D., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30647-5 · Cited by 218 · see citing works
Self-citationThe Diabetes Prevention Program Outcomes Study Research Group; prepared on behalf of the DPPOS Research Group, Orchard, T. J., Temprosa, M., Barrett‐Connor, E., Fowler, S. E., Goldberg, R. B., Mather, K. J., Marcovina, S. M., Montez, M., Ratner, R. E., et al. (2013) · Diabetic Medicine · doi:10.1111/j.1464-5491.2012.03750.x · Cited by 214 · see citing works
Warkentin, L. M., Das, D., Majumdar, S. R., Johnson, J. A., & Padwal, R. S. (2013) · Obesity Reviews · doi:10.1111/obr.12113 · Cited by 202 · see citing works
Guidelines (2013) for managing overweight and obesity in adults
(2014) · Obesity · doi:10.1002/oby.20818 · Cited by 172 · see citing works
Astbury, N. M., Aveyard, P., Nickless, A., Hood, K., Corfield, K., Lowe, R., & Jebb, S. A. (2018) · BMJ · doi:10.1136/bmj.k3760 · Cited by 155 · see citing works
Self-citationHartmann‐Boyce, J., Johns, D. J., Jebb, S. A., Summerbell, C. D., Aveyard, P. N., & Behavioural Weight Management Review Group (2014) · Obesity Reviews · doi:10.1111/obr.12220 · Cited by 149 · see citing works
Self-citationKent, S., Fusco, F., Gray, A. M., Jebb, S. A., Cairns, B. J., & Mihaylova, B. (2017) · Obesity Reviews · doi:10.1111/obr.12560 · Cited by 137 · see citing works
Self-citationParretti, H. M., Jebb, S. A., Johns, D. J., Lewis, A. L., Christian‐Brown, A. M., & Aveyard, P. (2016) · Obesity Reviews · doi:10.1111/obr.12366 · Cited by 118 · see citing works
Self-citationThe long‐term cost‐effectiveness of obesity prevention interventions: systematic literature review
Lehnert, T., Sonntag, D., Konnopka, A., Riedel-Heller, S. G., & König, H. ‐. (2012) · Obesity Reviews · doi:10.1111/j.1467-789x.2011.00980.x · Cited by 110 · see citing works
Coping with multiple morbidity in a life table
Barendregt, J. J., van Oortmarssen, G. J., van Hout, B. A., Bosch, J. M. V. D., & Bonneux, L. G. A. (1998) · Mathematical Population Studies · doi:10.1080/08898489809525445 · Cited by 99 · see citing works
Scarborough, P., Harrington, R., Mizdrak, A., Zhou, L. M., & Doherty, A. (2014) · Scientifica · doi:10.1155/2014/748750 · Cited by 85 · see citing works
Long-term cost-effectiveness of weight management in primary care
Counterweight Project Team*, Trueman, P., Haynes, S. M., Lyons, G., McCombie, L., McQuigg, M., Mongia, S., Noble, P. A., Quinn, M. F., Ross, H. M., et al. (2010) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2010.02349.x · Cited by 72 · see citing works
By-Band-Sleeve Trial Management Group, Doble, B., Wordsworth, S., Rogers, C. A., Welbourn, R., Byrne, J. P., & Blazeby, J. M. (2017) · Obesity Surgery · doi:10.1007/s11695-017-2749-8 · Cited by 71 · see citing works
Cost-effectiveness of pharmacological anti-obesity treatments: a systematic review
Neovius, M., & Narbro, K. (2008) · International Journal of Obesity · doi:10.1038/ijo.2008.189 · Cited by 51 · see citing works
Kent, S., Green, J., REEVES, G. K., Beral, V., Gray, A. M., Jebb, S. A., Cairns, B. J., Mihaylova, B., Abbiss, H., Abbott, S., et al. (2017) · The Lancet Public Health · doi:10.1016/s2468-2667(17)30062-2 · Cited by 50 · see citing works
Self-citationRetat, L., Pimpin, L., Webber, L., Jaccard, A., Lewis, A. L., Tearne, S., Hood, K., Christian-Brown, A., Adab, P., Begh, R. A., et al. (2019) · International Journal of Obesity · doi:10.1038/s41366-018-0295-7 · Cited by 35 · see citing works
Self-citationPicot, J., Jones, J., Colquitt, J. L., Gospodarevskaya, E., Loveman, E., Baxter, L., & Clegg, A. J. (2010) · Clinical Governance An International Journal · doi:10.1108/cgij.2010.24815aae.002 · Cited by 28 · see citing works
Orlistat for the treatment of obesity: cost utility model
FOXCROFT, D. R. (2005) · Obesity Reviews · doi:10.1111/j.1467-789x.2005.00211.x · Cited by 25 · see citing works
Jebb, S. A., Astbury, N. M., Tearne, S., Nickless, A., & Aveyard, P. N. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016709 · Cited by 21 · see citing works
Self-citationThe Diabetes Prevention Program Research Group. (2013) · Diabetes Care · doi:10.2337/dc13-er12c · Cited by 6 · see citing works
Hartmann‐Boyce, J., Johns, D. J., Jebb, S. A., & Aveyard, P. N. (2015) · Appetite · doi:10.1016/j.appet.2014.12.150 · Cited by 3 · see citing works
Self-citationA systematic review of weight regain after behavioural weight management programme end
Johns, D. J., Hartmann-Boyce, J., Langford, O., Perera, R., Jebb, S. A., & Aveyard, P. N. (2015) · Appetite · doi:10.1016/j.appet.2014.12.151 · Cited by 2 · see citing works
Self-citationBriggs, A. D. M. (2017) · Oxford University Research Archive (ORA) (University of Oxford) · doi:10.5287/ora-o885njxnx · Cited by 1 · see citing works
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Boyers, D., Retat, L., Jacobsen, E., Avenell, A., Aveyard, P. N., Corbould, E., Jaccard, A., Cooper, D., Robertson, C., Aceves‐Martins, M., et al. (2021) · International Journal of Obesity · doi:10.1038/s41366-021-00849-8 · Cited by 48 · see citing works
Self-citationDhungana, R. R., Pedišić, Ž., & de Courten, M. (2022) · BMC Family Practice · doi:10.1186/s12875-022-01884-8 · Cited by 40 · see citing works
Hartmann‐Boyce, J., Cobiac, L. J., Theodoulou, A., Oke, J. L., Butler, A. R., Scarborough, P., Bastounis, A., Dunnigan, A., Byadya, R., Hobbs, F. D. R., et al. (2023) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.14895 · Cited by 34 · see citing works
Self-citationAstbury, N. M., Albury, C., Nourse, R., & Jebb, S. A. (2020) · PLOS ONE · doi:10.1371/journal.pone.0238645 · Cited by 30 · see citing works
Self-citationKoutoukidis, D. A., Mózes, F. E., Jebb, S. A., Tomlinson, J., Pavlides, M., Saffioti, F., Huntriss, R., Aveyard, P. N., & Cobbold, J. (2023) · Obesity · doi:10.1002/oby.23793 · Cited by 19 · see citing works
Self-citationWeight Loss Treatment and Longitudinal Weight Change Among Primary Care Patients With Obesity
Henderson, J., Ehlers, A. P., Lee, J. M., Kraftson, A. T., Piehl, K., Richardson, C. R., & Hafez, D. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.56183 · Cited by 18 · see citing works
Jacobsen, E., Boyers, D., Manson, P. D., & Avenell, A. (2022) · Current Obesity Reports · doi:10.1007/s13679-022-00483-z · Cited by 15 · see citing works
Definition, prevalence, and economic impacts of hypertension on the elderly population
Lien, C.-W., Lee, Y., Lu, C., Chang, Y.-C., Lin, Y., Cheng, H., Chen, M. Y., Lee, L., Huang, C.-K., Lin, Y., et al. (2025) · Journal of the Formosan Medical Association · doi:10.1016/j.jfma.2025.02.020 · Cited by 13 · see citing works
Koutoukidis, D. A., Jebb, S. A., Foster, C. L., Wheatstone, P., Horne, A., Hill, T. M., Taylor, A. M., Realpe, A. X., Achana, F. A., & Buczacki, S. J. A. (2023) · Colorectal Disease · doi:10.1111/codi.16687 · Cited by 13 · see citing works
Self-citationPRIMEtime: an epidemiological model for informing diet and obesity policyPreprint
Cobiac, L. J., Law, C., & Scarborough, P. (2022) · medRxiv · doi:10.1101/2022.05.18.22275284 · Cited by 13 · see citing works
Astbury, N. M., Edwards, R. M., Ghebretinsea, F., Shanyinde, M., Mollison, J., Aveyard, P. N., & Jebb, S. A. (2021) · International Journal of Obesity · doi:10.1038/s41366-021-00915-1 · Cited by 12 · see citing works
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Morris, E. M., Jebb, S. A., & Aveyard, P. N. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(19)30071-3 · Cited by 12 · see citing works
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Briggs, A. D. M., Wolstenholme, J. L., & Scarborough, P. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4292-x · Cited by 10 · see citing works
Bates, S. E., Bayley, T., Norman, P. E., Breeze, P. R., & Brennan, A. (2019) · Medical Decision Making · doi:10.1177/0272989x19889897 · Cited by 9 · see citing works
Astbury, N. M., Tudor, K., Aveyard, P. N., & Jebb, S. A. (2020) · BMC Medicine · doi:10.1186/s12916-020-01547-4 · Cited by 9 · see citing works
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Hoog, M. M., Kan, H. J., Deger, K. A., Sorensen, S. V., Neff, L. M., Bae, J. P., Hankosky, E. R., Murphy, M., Mojdami, D., Houisse, I., et al. (2025) · Obesity · doi:10.1002/oby.24310 · Cited by 7 · see citing works
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Getaneh, A. M., Pol, M. M. V. D., Boyers, D., Avenell, A., Cotton, S. C., Dombrowski, S. U., Gray, C. M., Kee, F., Macaulay, L., McKinley, M. C., et al. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.5058444
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Talbot, A., Foster, C. L., Jebb, S. A., Wheatstone, P., Buczacki, S. J. A., & Koutoukidis, D. A. (2026) · Health Expectations · doi:10.1111/hex.70896
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Self-citation
- Authors
- Kent, S., Aveyard, P., Astbury, N., Mihaylova, B., & Jebb, S. A.
- Affiliations
- University of Oxford (GB)
- Queen Mary University of London (GB)
- Corresponding author
- Kent, Seamus
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2019-02-25
- Volume
- 27
- Issue
- 3
- Pages
- 391-398
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- OpenAlex
- W2922148072
- Cited by
- 35
- References
- 39
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 7 · 2023: 4 · 2022: 5 · 2021: 3 · 2020: 2 · 2019: 4
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Obesity (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Cambridge Weight Plan UK Ltd
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- total diet replacement, cost-effectiveness, weight regain, quality-adjusted life years, health care costs, weight loss maintenance, commercial weight loss programs
- MeSH terms
- Adult, Aged, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Obesity, Referral and Consultation, Weight Loss, Young Adult
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