Cost effectiveness of an internet-delivered lifestyle intervention in primary care patients with high cardiovascular risk |
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| Affiliation: | 1. Section of Decision Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States;2. Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States;3. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States;4. Center for Aging and Population Health Prevention Research Center, University of Pittsburgh, Pittsburgh, PA, United States;5. Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States;6. Health System Innovation and Research Program, University of Utah, United States;7. College of Public Health, Kent State University, Kent, OH, United States;8. Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States;1. International Centre for Allied Health Evidence, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia;2. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA;3. College of Health Solutions, Arizona State University, Phoenix, AZ, USA;4. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA;1. Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia;2. School of Medicine, Deakin University, Geelong, VIC, Australia;3. School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia;4. Department of Psychology, University of California Berkeley, CA, USA;5. Barwon Health, Geelong Hospital, Geelong, VIC, Australia;6. Monash Health, Melbourne, VIC, Australia;7. School of Clinical Sciences, Monash University VIC, Australia;8. Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia;9. Orygen Youth Health Research Centre, Parkville, VIC, Australia;10. Mental Health Research Institute, Parkville, VIC, Australia;11. Centre for Adolescent Health, Murdoch Children''s Research Centre, Parkville, VIC, Australia;12. Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, Australia;13. Department of Cardiology, Royal Brisbane and Women''s Hospital, QLD, Australia;14. School of Medicine, University of Queensland, QLD, Australia;15. Department of Psychiatry & Behavioral Medicine, Stanford University & Palo Alto University, CA, USA;p. Western Medical School, The University of Melbourne, St Albans, VIC, Australia;1. Academic Department of Child Health, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent ST4 6QG, UK;2. Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Stoke-on-Trent ST4 7QB, UK;3. Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK;1. Department of Orthopedics Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;2. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;3. Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA |
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| Abstract: | ObjectiveTo assess the cost-effectiveness of an online adaptation of the diabetes prevention program (ODPP) lifestyle intervention.MethodsODPP was a before–after evaluation of a weight loss intervention comprising 16 weekly and 8 monthly lessons, incorporating behavioral tools and regular, brief, web-based individualized counseling in an overweight/obese cohort (mean age 52, 76% female, 92% white, 28% with diabetes). A Markov model was developed to estimate ODPP cost effectiveness compared with usual care (UC) to reduce metabolic risk over 10 years. Intervention costs and weight change outcomes were obtained from the study; other model parameters were based on published reports. In the model, diabetes risk was a function of weight change with and without the intervention.ResultsCompared to UC, the ODPP in our cohort cost $14,351 and $29,331 per quality-adjusted life-year (QALY) gained from the health care system and societal perspectives, respectively. In a hypothetical cohort without diabetes, the ODPP cost $7777 and $18,263 per QALY gained, respectively. Results were robust in sensitivity analyses, but enrolling cohorts with lower annual risk of developing diabetes (≤ 1.8%), enrolling fewer participants (≤ 15), or increasing the hourly cost (≥$91.20) or annual per-participant time (≥ 1.45 h) required for technical support could increase ODPP cost to >$20,000 per QALY gained. In probabilistic sensitivity analyses, ODPP was cost-effective in 20–58% of model iterations using an acceptability threshold of $20,000, 73–92% at $50,000, and 95–99% at $100,000 per QALY gained.ConclusionsThe ODPP may offer an economical approach to combating overweight and obesity. |
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