Abstract
ObjectivesTo determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases.MethodsAn economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.ResultsRYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.ConclusionsRYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.
Highlights
In England, 26% of adult men and 29% of adult women are obese (BMI ≥ 30 kg/m2) [1]
Surgery is only available in the general population for people with a Body Mass Index (BMI) ≥ 40 kg/m2, or a BMI ≥ 35 kg/m2 for patients who have other significant comorbidities such as (T2DM) and who have previously tried and failed to achieve or maintain adequate weight loss [6]
VLCDs added to WMP1 compared to WMP1 alone, in order to assess the value of adding VLCDs to existing weight management programmes
Summary
In England, 26% of adult men and 29% of adult women are obese (BMI ≥ 30 kg/m2) [1]. Adults with severe obesity, defined here as having a Body Mass Index (BMI) ≥ 35 kg/m2, have substantially increased incidence of cardiovascularSciences, IQ Healthcare, Nijmegen, The Netherlands disease, stroke, respiratory disease, and cancer, which severely limit quality and length of life [2, 3]. The most recent National Institute for Health and Care Excellence (NICE) obesity clinical guidance (CG189), published in 2014, recommends multicomponent weight management programmes (WMPs) [6]. These should include behaviour change strategies to help increase physical activity (30 min of moderate or greater intensity physical activity on five or more days a week) and improve dietary behaviour (suggesting calorie deficits of 600 kcal/day for sustainable weight loss). Very low calorie diets (VLCDs, ≤800 kcal/day) were only recommended for people with a clinically assessed need to lose weight rapidly, for example those scheduled for joint replacement surgery or fertility treatment. Surgery is only available in the general population for people with a BMI ≥ 40 kg/m2, or a BMI ≥ 35 kg/m2 for patients who have other significant comorbidities such as (T2DM) and who have previously tried and failed to achieve or maintain adequate weight loss [6]
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