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Cited by 37Health Systems, Economic Evaluations, Quality of LifeObesity, Physical Activity, DietObesity and Health Practices

Cost-effectiveness of a primary care intervention to treat obesity

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Tsai, A G, Wadden, T A, Volger, S, Sarwer, D B, Vetter, M, Kumanyika, S, Berkowitz, R I, Diewald, L K +4 more·2013·International Journal of Obesity
DOI 10.1038/ijo.2013.94PMC PMC3786743
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Abstract

Background Data on the cost-effectiveness of the behavioral treatment of obesity are not conclusive. The cost-effectiveness of treatment in primary care settings is particularly relevant. Methods We conducted a within-trial cost-effectiveness analysis of a primary care-based obesity intervention. Study participants were randomized to: Usual Care (UC; quarterly visits with their primary care provider); Brief Lifestyle Counseling (BLC; quarterly provider visits plus monthly weight loss counseling visits) or Enhanced Brief Lifestyle Counseling (EBLC; all above interventions, plus choice of meal replacements or weight loss medication). A health-care payer perspective was used. Intervention costs were estimated from tracking data obtained prospectively. Quality-adjusted life years (QALYs) were estimated with the EuroQol-5D. We estimated cost per kilogram-year of weight loss and cost per QALY. Results Weight losses after 2 years were 1.7, 2.9 and 4.6 kg for UC, BLC and EBLC, respectively (P=0.003 for comparison of EBLC vs UC). The incremental cost per kilogram-year lost was $292 for EBLC compared with UC (95% confidence interval (CI): $219-$437). The short-term incremental cost per QALY was $115,397, but the 95% CI were undefined. Comparison of short-term cost per kg with published estimates of longer-term cost per QALY suggested that the intervention could be cost-effective over the long term (≥ 10 years). Conclusions A primary care intervention that includes monthly counseling visits and a choice of meal replacements or weight loss medication could be a cost-effective treatment for obesity over the long term. However, additional studies are needed on the cost-effectiveness of behavioral treatment of obesity.

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  • Interventions are considered cost-effective if their incremental cost-effectiveness ratio is below $50,000-$100,000 per QALY in the U.S. or £20,000-£30,000 in the UK.

    “Interventions are considered cost-effective if their incremental cost-effectiveness ratio (ICER) is below $50,000–$100,000 per QALY in the U.S. or £20,000–£30,000 in the UK [173, 174].”

    From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [173]

    The Analysis section (Sampling Uncertainty; page not provided) uses $50,000 and $100,000 per QALY as acceptability thresholds, supporting the U.S.-dollar portion of the claim. The cited paper does not establish a UK threshold of £20,000–£30,000 per QALY. (LLM, conf=0.88)

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Authors
Tsai, A. G., Wadden, T. A., Volger, S., Sarwer, D. B., Vetter, M., Kumanyika, S., Berkowitz, R. I., Diewald, L. K., Perez, J., Lavenberg, J., Panigrahi, E. R., & Glick, H. A.
Affiliations
  • University of Colorado Anschutz (US)
  • Haverford College (US)
  • University of Pennsylvania (US)
  • Children's Hospital of Philadelphia (US)
  • Leonard Davis Institute of Health Economics (US)
Corresponding author
Tsai, A G
ORCID
Venue
International Journal of Obesity
Publisher
Springer Science and Business Media LLC
Published
2013-08
Volume
37
Issue
S1
Pages
S31-S37
ISSN
  • 0307-0565 (ISSN-L)
  • 1476-5497
DOI
10.1038/ijo.2013.94
PMC
PMC3786743
OpenAlex
W2033268404
Cited by
37
References
50
Citations by year
2026: 1 · 2025: 4 · 2022: 1 · 2020: 4 · 2019: 3 · 2018: 8 · 2017: 2 · 2016: 2 · 2015: 3 · 2014: 8 · 2013: 1
FWCI
10.95
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • International Journal of Obesity (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • University of Pennsylvania
  • National Institutes of Health (5u01hl087072-05, 5k24dk065018-10)
  • National Heart, Lung, and Blood Institute (U01-HL087072)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K24-DK-065018, DK065018)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords
obesity, cost-effectiveness, primary care, behavioral weight loss, lifestyle counseling, meal replacement, anti-obesity drugs, quality-adjusted life years, weight loss
MeSH terms
Cost-Benefit Analysis, Diet, Reducing, Female, Medicare, Humans, Male, Medicaid, Middle Aged, Obesity, Pennsylvania, Primary Health Care, Quality of Life, Time Factors, United States, Weight Loss, Quality-Adjusted Life Years, Directive Counseling, Risk Reduction Behavior

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