Within trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study

Mace Coday,Mark A Espeland,Helen P Hazuda,Maria G Montez,Look Ahead Research Group,Tina Killean,Edward S Horton,Frank L Greenway,Haiying Chen,Edward W Gregg,Anne Peters,James O Hill,William C Knowler,Peter J Huckfeldt,Jennifer Patricio,Rena R Wing,Helmut Steinburg,John M Jakicic,Gareth R Dutton,John P Foreyt,Ping Zhang,Steven E Kahn,Cora E Lewis,Susan Z Yanovski,Thomas A Wadden,Nisa M Maruthur,Robert W Jeffery,Jeanne M Clark,Mary Evans,Sara Michaels,Holly R Wyatt ,Henry J Pownall ,Julia Rushing ,George A Bray ,Karen Johnson ,Caitlin E Egan ,Karen M Atkinson ,David M Nathan ,Mary T Korytkowski ,Sharon D Jackson ,J Bruce Redmon ,Xavier Pi‐Sunyer ,Van S Hubbard

doi:10.2337/figshare.13084802

Abstract

OBJECTIVE To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. RESEARCH DESIGN AND METHODS Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. RESULTS <a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. Conclusions Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.

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