Cost‐Effectiveness of a Low‐Carbohydrate Diet and a Standard Diet in Severe Obesity
Open accessAbstract
Objective: Low‐carbohydrate diets have become a popular alternative to standard diets for weight loss. Our aim was to compare the cost‐effectiveness of these two diets. Research Methods and Procedures: The patient population included 129 severely obese subjects (BMI = 42.9) from a randomized trial; participants had a high prevalence of diabetes or metabolic syndrome. We compared within‐trial costs, quality‐adjusted life years (QALYs), and the incremental cost‐effectiveness ratio (CER) for the two study groups. We imputed missing values for QALYs. The CER was bootstrapped to derive 95% confidence intervals and to define acceptability cut‐offs. We took a societal perspective for our analysis. Results: Total costs during the one year of the trial were $6742 ± 6675 and $6249 ± 5100 for the low‐carbohydrate and standard groups, respectively (p= 0.78). Participants experienced 0.64 ± 0.02 and 0.61 ± 0.02 QALYs during the one year of the study, respectively (p= 0.17 for difference). The point estimate of the incremental CER was $−1225/QALY (i.e., the low‐carbohydrate diet dominated the standard diet). However, in the bootstrap analysis, the wide spread of CERs caused the 95% confidence interval to be undefined. The probabilities that the low‐carbohydrate diet was acceptable, using cut‐offs of $50, 000/QALY, $100, 000/QALY, and $150, 000/QALY, were 72.4% 78.6%, and 79.8%, respectively. Discussion: The low‐carbohydrate diet was not more cost‐effective for weight loss than the standard diet in the patient population studied. Larger studies are needed to better assess the cost‐effectiveness of dietary therapies for weight loss.
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The evidence on relative cost-effectiveness of weight-loss diet programmes is limited from head-to-head diet comparison trials, but one RCT showed that LCD was not more cost-effective than the standard weight-loss diet.
“The evidence on relative cost-effectiveness of weight-loss diet programmes is limited from head-to-head diet comparison trials, but one RCT showed that LCD was not more cost-effective than the standard weight-loss diet [61].”
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Cites
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
(2002) · New England Journal of Medicine · doi:10.1056/nejmoa012512 · Cited by 19,011 · see citing works
(1998) · PsycEXTRA Dataset · doi:10.1037/e565682010-001 · Cited by 9,452 · see citing works
Cost-Effectiveness in Health and Medicine
(1996) · doi:10.1093/oso/9780195108248.001.0001 · Cited by 7,193 · see citing works
The estimation of a preference-based measure of health from the SF-36.
Brazier, J., Roberts, J., & Deverill, M. (2002) · Journal of Health Economics · doi:10.1016/s0167-6296(01)00130-8 · Cited by 3,164 · see citing works
(1998) · PubMed · Cited by 2,737 · see citing works
Smearing Estimate: A Nonparametric Retransformation Method
Duan, N.-H. (1983) · Journal of the American Statistical Association · doi:10.1080/01621459.1983.10478017 · Cited by 2,289 · see citing works
A Randomized Trial of a Low-Carbohydrate Diet for Obesity
Foster, G. D., Wyatt, H. R., Hill, J. O., McGuckin, B. G., Brill, C., Mohammed, B. S., Szapary, P. O., Rader, D. J., Edman, J. S., & Klein, S. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022207 · Cited by 1,794 · see citing works
Dansinger, M. L., Gleason, J. A., Griffith, J. L., Selker, H. P., & Schaefer, E. J. (2005) · JAMA · doi:10.1001/jama.293.1.43 · Cited by 1,726 · see citing works
A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity
Samaha, F. F., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., Williams, T., Williams, M., Gracely, E. J., & Stern, L. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022637 · Cited by 1,267 · see citing works
Self-citationThe Effects Of Obesity, Smoking, And Drinking On Medical Problems And Costs
Sturm, R. (2002) · Health Affairs · doi:10.1377/hlthaff.21.2.245 · Cited by 987 · see citing works
The logged dependent variable, heteroscedasticity, and the retransformation problem.
Manning, W. (1998) · Journal of Health Economics · doi:10.1016/s0167-6296(98)00025-3 · Cited by 959 · see citing works
Yancy, W. S., Olsen, M. K., Guyton, J. R., Bakst, R. P., & Westman, E. C. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-10-200405180-00006 · Cited by 946 · see citing works
Stern, L., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., Williams, M., Gracely, E. J., & Samaha, F. F. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-10-200405180-00007 · Cited by 831 · see citing works
Self-citationBrehm, B. J., Seeley, R. J., Daniels, S. R., & D’Alessio, D. A. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-021480 · Cited by 830 · see citing works
Dietary Guidelines for Americans, 2005
Mosocco, D. J. (2006) · Home Healthcare Now · doi:10.1097/00004045-200610000-00002 · Cited by 801 · see citing works
Herman, W. H., Hoerger, T. J., Brandle, M., Hicks, K., Sorensen, S., Zhang, P., Hamman, R. F., Ackermann, R. T., Engelgau, M. M., Ratner, R. E., et al. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-5-200503010-00007 · Cited by 703 · see citing works
Stem, L., Iqbal, N., Seshadri, P., & Chicano, K. L. (2004) · ACC Current Journal Review · doi:10.1016/j.accreview.2004.07.103 · Cited by 629 · see citing works
What Is the Price of Life and Why Doesn't It Increase at the Rate of Inflation?
Ubel, P. A., Hirth, R. A., Chernew, M. E., & Fendrick, A. M. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.14.1637 · Cited by 588 · see citing works
Boden, G., Sargrad, K., Homko, C., Mozzoli, M., & Stein, T. P. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-6-200503150-00006 · Cited by 542 · see citing works
Modeling risk using generalized linear models.
Blough, D., Madden, C., & Hornbrook, M. (1999) · Journal of Health Economics · doi:10.1016/s0167-6296(98)00032-0 · Cited by 473 · see citing works
Estimating Medical Costs from Incomplete Follow-Up Data
Lin, D. Y., Feuer, E. J., Etzioni, R., & Wax, Y. (1997) · Biometrics · doi:10.2307/2533947 · Cited by 455 · see citing works
Barkeling, B., Rössner, S., & Björvell, H. (1990) · PubMed · Cited by 201 · see citing works
Quantifying stochastic uncertainty and presenting results of cost-effectiveness analyses
Glick, H. A., Briggs, A. H., & Polsky, D. E. (2001) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/14737167.1.1.25 · Cited by 113 · see citing works
Self-citationUsing Average Cost Methods to Estimate Encounter-Level Costs for Medical-Surgical Stays in the VA
Wagner, T. H., Chen, S., & Barnett, P. G. (2003) · Medical Care Research and Review · doi:10.1177/1077558703256485 · Cited by 103 · see citing works
Computerized Weight Loss Intervention Optimizes Staff Time
WYLIE-ROSETT, J., SWENCIONIS, C., GINSBERG, M., CIMINO, C., WASSERTHEIL-SMOLLER, S., CABAN, A., SEGAL-ISAACSON, C., MARTIN, T., & LEWIS, J. (2001) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(01)00284-x · Cited by 96 · see citing works
Clinical and Cost Outcomes of Medical Nutrition Therapy for Hypercholesterolemia
Delahanty, L. M., Sonnenberg, L. M., Hayden, D. L., & Nathan, D. M. (2001) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(01)00250-4 · Cited by 89 · see citing works
Estimating the Costs of VA Ambulatory Care
Phibbs, C. S., Bhandari, A., Yu, W., & Barnett, P. G. (2003) · Medical Care Research and Review · doi:10.1177/1077558703256725 · Cited by 69 · see citing works
Brazier, J. E., Kolotkin, R. L., Crosby, R. D., & Williams, G. R. (2004) · Value in Health · doi:10.1111/j.1524-4733.2004.74012.x · Cited by 63 · see citing works
The cost of losing: an analysis of commercial weight-loss programs in a metropolitan area.
Spielman, A. B., Kanders, B. S., Kienholz, M., & Blackburn, G. L. (1992) · Journal of the American College of Nutrition · doi:10.1080/07315724.1992.10718194 · Cited by 32 · see citing works
Downey, M. (2001) · American Heart Journal · doi:10.1067/mhj.2001.119421 · Cited by 21 · see citing works
Technical Skills for Weight Loss: Preliminary Data from a Randomized Trial
Katz, D. L., Chan, W., Gonzalez, M., Larson, D., Nawaz, H., Abdulrahman, M., & Yeh, M. (2002) · Preventive Medicine · doi:10.1006/pmed.2002.1025 · Cited by 10 · see citing works
Weight Loss With Self-help Compared With a Structured Commercial Program: A Randomized Trial
Heshka, S., Anderson, J. W., Atkinson, R. L., Greenway, F. L., Hill, J. O., Phinney, S. D., Kolotkin, R. L., Miller-Kovach, K., & Pi-Sunyer, F. X. (2003) · JAMA · doi:10.1001/jama.289.14.1792 · Cited by 7 · see citing works
Monden, Y. (2019) · Routledge eBooks · doi:10.4324/9780203735350-1 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Hession, M., Rolland, C., Kulkarni, U., Wise, A., & Broom, J. I. (2008) · Obesity Reviews · doi:10.1111/j.1467-789x.2008.00518.x · Cited by 394 · see citing works
“…LC/HP vs. LF/HC 30 g LF – kcal restricted Truby et al., 2006 (20) Atkins vs. LF/HC 20 g increased to 5 g week-1 when 10 lb away from target weight LF – kcal restricted Tsai et al., 2005 (21) LC/HP vs. LF/HC 30 g increased to 50 g gradually LF – kcal restricted Yancy et al., 2004 (22) VLC/HP vs.…”
BackgroundSantos, F. L., Esteves, S. S., da Costa Pereira, A., Yancy Jr, W. S., & Nunes, J. P. L. (2012) · Obesity Reviews · doi:10.1111/j.1467-789x.2012.01021.x · Cited by 318 · see citing works
Churuangsuk, C., Hall, J., Reynolds, A., Griffin, S. J., Combet, E., & Lean, M. E. J. (2022) · Diabetologia · doi:10.1007/s00125-021-05577-2 · Cited by 204 · see citing works
“The evidence on relative cost-effectiveness of weight-loss diet programmes is limited from head-to-head diet comparison trials, but one RCT showed that LCD was not more cost-effective than the standard weight-loss diet [61].”
BackgroundEspeland, M. A., Glick, H. A., Bertoni, A., Brancati, F. L., Bray, G. A., Clark, J. M., Curtis, J. M., Egan, C., Evans, M., Foreyt, J. P., et al. (2014) · Diabetes Care · doi:10.2337/dc14-0093 · Cited by 174 · see citing works
Self-citationCost-Effectiveness of a Telephone-Delivered Intervention for Physical Activity and Diet
Graves, N., Barnett, A. G., Halton, K. A., Veerman, L. J., WINKLER, E. A. H., Owen, N. G., Reeves, M. M., Marshall, A. L., & Eakin, E. (2009) · PLoS ONE · doi:10.1371/journal.pone.0007135 · Cited by 115 · see citing works
“[48] used cost and outcome data collected from a trial that recruited severely obese individuals who were randomised to a low carbohydrate or standard weight loss program and concluded the novel diet was not cost-effective.”
MethodImproving Lifestyles, Tackling Obesity: The Health and Economic Impact of Prevention Strategies
Sassi, F., Cecchini, M., Lauer, J. A., & Chisholm, D. (2009) · OECD health working papers · doi:10.1787/220087432153 · Cited by 108 · see citing works
Gjuladin-Hellon, T., Davies, I. G., Penson, P., & Amiri Baghbadorani, R. (2019) · Nutrition Reviews · doi:10.1093/nutrit/nuy049 · Cited by 108 · see citing works
Avenell, A., Robertson, C., Skea, Z., Jacobsen, E., Boyers, D., Cooper, D., Aceves‐Martins, M., Retat, L., Fraser, C. M., Aveyard, P. N., et al. (2018) · Health Technology Assessment · doi:10.3310/hta22680 · Cited by 100 · see citing works
Dalziel, K., & Segal, L. (2007) · Health Promotion International · doi:10.1093/heapro/dam027 · Cited by 96 · see citing works
“…and converted to AUS$, US$ and/or £ Dalziel et al. (2005) Mediterranean diet versus western diet for those with previous MI AU $1031a (US $772, £414) Tsai et al. (2005) Low carbohydrate diet versus standard diet for obesity Intervention (low carbohydrate diet) dominates Ackermann et al. (2006)…”
BackgroundGordon, L., Graves, N., Hawkes, A., & Eakin, E. (2007) · Chronic Illness · doi:10.1177/1742395307081732 · Cited by 77 · see citing works
“(2005) found a low carbohydrate dietary intervention was dominant over a standard diet, but the differences in costs and in QALYs across the two options were not statistically significant.(74) For a dietitian counselling plus multidisciplinary care intervention, the incremental cost per patient achieving glycemic cont…”
BackgroundCost, Effectiveness, and Cost-Effectiveness
Diamond, G. A., & Kaul, S. (2009) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.108.793406 · Cited by 76 · see citing works
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
Makris, A., & Foster, G. D. (2007) · Humana Press eBooks · doi:10.1007/978-1-59745-400-1_15 · Cited by 46 · see citing works
Galani, C., Schneider, H., & Rutten, F. (2007) · Sozial- und Präventivmedizin · doi:10.1007/s00038-007-7014-9 · Cited by 42 · see citing works
Manuel, M., Lesmes, I. B., Marset, J. B., Izquierdo, J. Q. I., Formiguera, X., & Salas‐Salvadó, J. (2012) · PubMed · doi:10.3305/nh.2012.27.3.5680 · Cited by 38 · see citing works
Cost-effectiveness of a primary care intervention to treat obesity
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., et al. (2013) · International Journal of Obesity · doi:10.1038/ijo.2013.94 · Cited by 37 · see citing works
Self-citationChoi, J. H., Cho, Y. J., Kim, H., Ko, S., Chon, S., Kang, J., Kim, E. M., Kim, H. J., Kim, H. J., Song, K., et al. (2022) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2022.0038 · Cited by 32 · see citing works
Gargallo-Fernández, M., Izquierdo, J. Q. I., Marset, J. B., Lesmes, I. B., Formiguera, X., & Salas‐Salvadó, J. (2012) · PubMed · doi:10.3305/nh.2012.27.3.5679 · Cited by 29 · see citing works
Economic Evaluations of Adult Weight Management Interventions
Griffiths, U. K., Anigbogu, B., & Nanchahal, K. (2012) · Applied Health Economics and Health Policy · doi:10.2165/11599250-000000000-00000 · Cited by 23 · see citing works
“during the trial using either EQ-5D or SF-36 instruments,([34,37,39,51]) and in one study scores from the literature were used.”
MethodChoi, J. H., Cho, Y. J., Kim, H., Ko, S., Chon, S., Kang, J., Kim, K. K., Kim, H. J., Kim, H. J., Song, K., et al. (2022) · Clinical Hypertension · doi:10.1186/s40885-022-00207-4 · Cited by 21 · see citing works
Perri, M. G., Ariel-Donges, A. H., Shankar, M. N., Limacher, M. C., Daniels, M. J., Janicke, D. M., Ross, K. M., Bobroff, L. B., Martin, A. D., Radcliff, T. A., et al. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.11.006 · Cited by 16 · see citing works
“Cost effectiveness will also be assessed based on Quality-Adjusted Life Year (QALY) gains related to weight change and will be calculated using data from the SF-36 questionnaires completed at baseline, Month 4, Month 16, and Month 22 to derive a preference score using the Short Form-6 Dimension (SF6D) method; 10 items…”
MethodEconomic effects of interventions to reduce obesity in Israel
Ginsberg, G. M., & Rosenberg, E. (2012) · Israel Journal of Health Policy Research · doi:10.1186/2045-4015-1-17 · Cited by 15 · 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
Critical review of economic evaluation studies of interventions promoting low-fat diets
Fattore, G., Ferré, F., Meregaglia, M., Fattore, E., & Agostoni, C. V. (2014) · Nutrition Reviews · doi:10.1111/nure.12142 · Cited by 11 · see citing works
Yancey, A. K., Cole, B. L., & McCarthy, W. J. (2010) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2010.05.013 · Cited by 9 · see citing works
Choi, J. H., Cho, Y. J., Kim, H., Ko, S., Chon, S., Kang, J., Kim, K. K., Kim, E. M., Kim, H. J., Song, K., et al. (2022) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes22009 · Cited by 8 · see citing works
Cresswell, L., & Mander, A. (2013) · Obesity · doi:10.1002/oby.20635 · Cited by 7 · see citing works
Obesidad y dietas: algunas controversias
Liaudat, A. (2008) · Evidencia actualizacion en la práctica ambulatoria · doi:10.51987/evidencia.v11i5.5859 · Cited by 2 · see citing works
Obesity and diets: some controversies
Liaudat, A. (2008)
(2007) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0b013e3280d5f7e9
Popular Indian Weight Loss Diets––Pros and Cons
Varghese, S. M., Parisi, S., Singla, R. K., & Begum, A. S. A. (2022) · Springer briefs in molecular science · doi:10.1007/978-3-031-06304-6_7
Choi, J. H., Cho, Y. J., Kim, H.-J., Ko, S.-H., Chon, S., Kang, J.-H., Kim, K.-K., Kim, E. M., Kim, H. J., Song, K., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19947735
- Authors
- Tsai, A. G., Glick, H. A., Shera, D., Stern, L., & Samaha, F. F.
- Affiliations
- University of Pennsylvania (US)
- Children's Hospital of Philadelphia (US)
- Philadelphia VA Medical Center (US)
- Corresponding author
- Samaha, Frederick F.
- ORCID
- Tsai, Adam Gilden
- Venue
- Obesity Research
- Publisher
- Wiley
- Published
- 2005-10
- Volume
- 13
- Issue
- 10
- Pages
- 1834-1840
- ISSN
- 1071-7323 (ISSN-L)
- 1550-8528
- OpenAlex
- W2061624169
- Cited by
- 33
- References
- 33
- Citations by year
- 2022: 6 · 2021: 2 · 2018: 3 · 2014: 2 · 2013: 2 · 2012: 5
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Obesity Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- U.S. Public Health Service (2-T32-HP-010026)
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- low-carbohydrate diet, standard diet, morbid obesity, weight loss, cost-effectiveness, quality-adjusted life years, incremental cost-effectiveness ratio, diabetes mellitus, metabolic syndrome, dietary therapy
- MeSH terms
- Adult, Cost-Benefit Analysis, Dietary Carbohydrates, Female, Humans, Male, Middle Aged, Obesity, Severity of Illness Index, Quality-Adjusted Life Years
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