Cost-Effectiveness of Structured Lifestyle Intervention in Overweight and Obese Adults with Type 2 Diabetes—Results from the Action for Health in Diabetes (Look AHEAD) Study

Abstract

Look AHEAD is a multicenter randomized clinical trial designed to examine the effects of an intensive lifestyle intervention (ILI), compared with diabetes support and education (DSE), for reducing cardiovascular events in 5,145 adults with overweight/obesity and type 2 diabetes. Here we reported the cost-effectiveness of the ILI, measured in costs per quality-adjusted life year (QALY), relative to DSE as implemented during the 10-year intervention period of the trial. Health utility (HU) values were measured using HU Index-2, HU Index-3, SF-6D and Feeling Thermometer. Cost were measured in 2012 U.S. dollars. All data were collected prospectively. QALYs were calculated as the product of predicted survival probability and predicted health utility values. Cumulative total cost was calculated as a sum of intervention cost and health expenditures, each of which was calculated as the product of predicted survival probability and predicted intervention cost and health expenditures. The estimated total and incremental QALYS and costs, and cost-effectiveness ratios (CER) are presented in the Table. ILI was likely to be not cost effective over the 10 year intervention period. Long term health benefits from the follow-up of the study participants can provide important information regarding the long-term cost-effectiveness of ILI.MeasurementsDSE (95% CI)ILI (95% CI)ILI-DSE (95%CI)CE Ratio (95% CI)HUI-2 (QALYs)6.08 (6.03, 6.13)6.10 (6.05, 6.15)0.03 (-0.04, 0.09)-----HUI-3 (QALYs)5.94 (5.88, 5.99)5.94 (5.87, 5.99)0 (-0.08, 0.07)-----SF-6D (QALYs)5.92 (5.88, 5.96)5.99 (5.95, 6.03)0.07 (0.02, 0.12)101,635 (42567, 320360)Feeling thermometer (QALYs)6.03 (5.98, 6.07)6.18 (6.67, 6.77)0.15 (0.10, 0.21)45,487 (23270, 81851)Total cost ($)78,466 (76324, 80708)85,490 (83341, 87666)7,024 (4121, 9932)----- Disclosure P. Zhang: None. H. Chen: None. M. Espeland: Consultant; Self; Boehringer Ingelheim GmbH, Janssen Pharmaceuticals, Inc.. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases, National Institute on Aging, National Heart, Lung, and Blood Institute. R.R. Wing: None. M.G. Montez: None. P.J. Huckfeldt: None. M. Evans: None. E.W. Gregg: None. W.C. Knowler: None.