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1.
BMJ Open ; 14(7): e073740, 2024 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-39043600

RESUMO

OBJECTIVES: We sought to extrapolate the long-term costs and clinical impacts attributed to the rugby fans in training-New Zealand (RUFIT-NZ) trial in Aotearoa, New Zealand. DESIGN: A modelled cost-effectiveness analysis using efficacy data from RUFIT-NZ was conducted from the Aotearoa New Zealand healthcare perspective. SETTING: A Markov cohort model was constructed with a lifetime time horizon. The model simulated events of myocardial infarction (MI), stroke and type 2 diabetes mellitus (T2DM) occurring among a hypothetical cohort of 10 000 individuals receiving either the RUFIT-NZ intervention or no intervention. Efficacy data were based on the RUFIT-NZ trial, and the latest Global Burden of Disease study was used to extrapolate the impact of body weight reduction on clinical outcomes of T2DM, MI or stroke. Cost and utility data were drawn from the RUFIT-NZ trial and published sources. PRIMARY OUTCOME MEASURES: The incremental cost-effectiveness ratio (ICER). RESULTS: Over a lifetime time horizon, participants in the RUFIT-NZ intervention gained 0.02 (discounted) quality-adjusted life years (QALYs) at an additional cost of NZ$863, relative to no intervention. The estimated ICER was NZ$49 515 per QALY gained (discounted), which is above the arbitrary willingness-to-pay threshold of NZ$45 000 per QALY. Sensitivity analyses supported the robustness of these findings. CONCLUSIONS: RUFIT-NZ was associated with a reduction in cardiovascular and endocrine events for overweight and obese males. However, based on conservative assumptions, RUFIT-NZ was unlikely to be cost-effective from a healthcare system perspective. TRIAL REGISTRATION NUMBER: ACTRN12619000069156.


Assuntos
Análise Custo-Benefício , Diabetes Mellitus Tipo 2 , Futebol Americano , Cadeias de Markov , Anos de Vida Ajustados por Qualidade de Vida , Humanos , Masculino , Nova Zelândia , Diabetes Mellitus Tipo 2/economia , Pessoa de Meia-Idade , Programas de Redução de Peso/economia , Programas de Redução de Peso/métodos , Adulto , Infarto do Miocárdio/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Redução de Peso , Idoso , Análise de Custo-Efetividade
2.
Front Public Health ; 12: 1381079, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38841679

RESUMO

Introduction: Overweight and obesity are a global health epidemic and many attempts have been made to address the rising prevalence. In March 2021 the UK government announced £100 million of additional funding for weight management provisions. Of this, £30.5 million was split across local authorities in England to support the expansion of tier two behavioural weight management services for adults. The present work aimed to explore how this funding was used within the Yorkshire and Humber region to consolidate learning, collate best practice, and provide recommendations for future funding use. Method: One-hour semi-structured interviews were conducted with 11 weight management service commissioners representing 9 of the 15 local authorities in the region. Interviews were recorded, transcribed and analysed using an established health inequality framework. From this, recommendations were co-developed with the commissioner group to establish best practice for future funding use. Results: Commissioners recognised that targeted weight management services were only one small piece of the puzzle for effectively managing obesity. Therefore, recommendations include targeting underserved communities, focussing on early prevention, addressing weight management in a whole systems context, and embracing innovative and holistic approaches to weight management. Discussion: Current short-term funding and restrictive commissioning processes of tier two services prevents sustainable and innovative weight management practice which is detrimental to patients, falls short of addressing health inequalities and negatively impacts staff health and wellbeing.


Assuntos
Obesidade , Humanos , Obesidade/prevenção & controle , Inglaterra , Adulto , Entrevistas como Assunto , Programas de Redução de Peso/economia , Sobrepeso/economia , Financiamento Governamental , Pesquisa Qualitativa
3.
BMJ Open ; 14(5): e084075, 2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38719295

RESUMO

INTRODUCTION: The reproductive years can increase women's weight-related risk. Evidence for effective postpartum weight management interventions is lacking and engaging women during this life stage is challenging. Following a promising pilot evaluation of the Supporting MumS intervention, we assess if theory-based and bidirectional text messages to support diet and physical activity behaviour change for weight loss and weight loss maintenance, are effective and cost-effective for weight change in postpartum women with overweight or obesity, compared with an active control arm receiving text messages on child health and development. METHODS AND ANALYSIS: Two-arm, parallel-group, assessor-blind randomised controlled trial with cost-effectiveness and process evaluations. Women (n=888) with body mass index (BMI) ≥25 kg/m2 and within 24 months of giving birth were recruited via community and National Health Service pathways through five UK sites targeting areas of ethnic and socioeconomic diversity. Women were 1:1 randomised to the intervention or active control groups, each receiving automated text messages for 12 months. Data are collected at 0, 6, 12 and 24 months. The primary outcome is weight change at 12 months from baseline, compared between groups. Secondary outcomes include weight change (24 months) and waist circumference (cm), proportional weight gain (>5 kg), BMI (kg/m2), dietary intake, physical activity, infant feeding and mental health (6, 12 and 24 months, respectively). Economic evaluation examines health service usage and personal expenditure, health-related quality of life and capability well-being to assess cost-effectiveness over the trial and modelled lifetime. Cost-utility analysis examines cost per quality-adjusted life-years gained over 24 months. Mixed-method process evaluation explores participants' experiences and contextual factors impacting outcomes and implementation. Stakeholder interviews examine scale-up and implementation. ETHICS AND DISSEMINATION: Ethical approval was obtained before data collection (West of Scotland Research Ethics Service Research Ethics Committee (REC) 4 22/WS/0003). Results will be published via a range of outputs and audiences. TRIAL REGISTRATION NUMBER: ISRCTN16299220.


Assuntos
Análise Custo-Benefício , Obesidade , Sobrepeso , Período Pós-Parto , Envio de Mensagens de Texto , Humanos , Feminino , Sobrepeso/terapia , Obesidade/terapia , Exercício Físico , Adulto , Índice de Massa Corporal , Reino Unido , Redução de Peso , Programas de Redução de Peso/métodos , Programas de Redução de Peso/economia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Anos de Vida Ajustados por Qualidade de Vida
4.
JAMA ; 332(1): 31-40, 2024 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-38744430

RESUMO

Importance: Effective weight loss interventions are needed for men with obesity. Objective: To determine whether an intervention that combined text messaging with financial incentives attained significant weight loss at the 12-month follow-up compared with the control group and whether an intervention of text messaging alone attained significant weight loss at the 12-month follow-up compared with the control group. Design, Setting, and Participants: An assessor-blinded randomized clinical trial conducted in Belfast, Bristol, and Glasgow areas in the UK. A total of 585 men with body mass index (BMI) of 30 or more were enrolled between July 2021 and May 2022. Final follow-up occurred June 2023. Interventions: Participants were randomly assigned to 12 months of behavioral focused text messages combined with financial incentives (n = 196), 12 months of behavioral focused text messages alone (n= 194), or a waiting list (control group; n= 195). The financial incentive consisted of a monetary reward that was lost if weight loss targets were not met. All participants received weight management information and a pedometer at baseline. Main Outcomes and Measures: The 2 primary comparisons were the 12-month comparison of within-participant weight change between the text messaging with financial incentive group and the control group and the comparison between the text messaging alone group and the control group (minimum clinically important difference, 3%). The P value defined for statistical significance was P < .025 for each comparison. Results: Of the 585 men (mean [SD] age, 50.7 [13.3] years; mean weight, 118.5 [19.9] kg; mean BMI, 37.7 [5.7]; 525 [90%] White), 227 (39%) lived in postal code areas with lower socioeconomic status, and 426 (73%) completed the 12-month follow-up. At the 12-month follow-up, compared with the control group, the mean percent weight change was significantly greater in the text messaging with financial incentive group (mean difference, -3.2%; 97.5% CI, -4.6% to -1.9%; P < .001) but was not significantly greater in the text messaging alone group (mean difference, -1.4%; 97.5% CI, -2.9% to 0.0, P = .05). The mean (SD) weight changes were -5.7 (7.4) kg for the text messaging with financial incentives group, -3.0 (7.5) kg for the text messaging alone group, and -1.5 (6.6) kg for the control group. The 12-month mean (SD) percentage weight changes from baseline were -4.8% (6.1%) for the text messaging with financial incentives group, -2.7% (6.3%) for text messaging alone group, and -1.3% (5.5%) for the control group. Of 366 adverse events reported, the most common were infections (83 [23%]). Of the 23 serious adverse events (6.3%), 12 (52%) occurred in the text messaging with financial incentives group, 5 (22%) in the texts messaging alone group, and 6 (26%) in the control group. None were considered related to participating in a trial group. Conclusion and Relevance: Among men with obesity, an intervention with text messaging with financial incentive significantly improved weight loss compared with a control group, whereas text messaging alone was not significantly better than the control condition. These findings support text messaging combined with financial incentives to attain weight loss in men with obesity. Trial Registration: isrctn.org Identifier: ISRCTN91974895.


Assuntos
Motivação , Obesidade , Envio de Mensagens de Texto , Programas de Redução de Peso , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Massa Corporal , Obesidade/terapia , Recompensa , Método Simples-Cego , Redução de Peso , Programas de Redução de Peso/métodos , Programas de Redução de Peso/economia , Reino Unido , População Branca
5.
J Acad Nutr Diet ; 122(1): 139-148, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34351276

RESUMO

BACKGROUND: The high rate of obesity, ownership of smartphones, and online search for nutrition and dieting information among African American women (AAW) provide a unique opportunity to develop cost-effective, accessible, and acceptable mHealth weight management programs for them. Furthermore, they should participate in the development and evaluation of these programs. OBJECTIVE: To explore ideal components of a culturally relevant mHealth weight management program for AAW and to examine how these components may vary by age group. DESIGN: Twelve focus group triads were conducted with AAW in north central Florida. The framework method was used to manage, organize, synthesize, and analyze data themes by age groups: 18 to 29 (young), 30 to 50 (middle age), and 51+ (older). PARTICIPANTS/SETTING: Thirty-six smartphone owners who expressed a desire to lose weight were recruited through several community partnerships. RESULTS: Based on body mass index (BMI), young women were classified as overweight (BMI 26.23 ± 6.7), middle-aged women as obese (BMI30.72 ± 8.31), and older women as obese (BMI 31.03 ± 5.67). Most searched online for dieting information within the past 12 months. Five overarching themes for designing mHealth weight management programs were identified: (1) holistic program that goes beyond dieting; (2) social media integration for support and sense of community; (3) self-monitoring app; (4) two-way text messaging; and (5) programs of varying lengths and meaningful incentives. CONCLUSION: AAW were receptive to mHealth weight management programs, which may be appealing during and after the COVID-19 pandemic. Holistic programs of 4 to 6 weeks that addressed stress eating, had a social media component, and included a few educational texts per week may be appealing to AAW.


Assuntos
Negro ou Afro-Americano , Grupos Focais , Saúde Holística , Telemedicina/métodos , Programas de Redução de Peso/métodos , Saúde da Mulher , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Índice de Massa Corporal , COVID-19 , Feminino , Florida/epidemiologia , Humanos , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/terapia , Sobrepeso/epidemiologia , Sobrepeso/terapia , SARS-CoV-2 , Smartphone , Programas de Redução de Peso/economia , Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
6.
PLoS One ; 16(2): e0246621, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571249

RESUMO

PURPOSE: To estimate potential annual savings in medical expenditures from a subsidized weight management program from the NYC Government perspective. DESIGN: Longitudinal observational study. SETTING: Employees of New York City (NYC) government and enrolled dependents. SAMPLE: 14,946 participants with overweight and obesity. INTERVENTION: WW (formerly Weight Watchers®) 'Workshop' and 'Digital' programs. MEASURES: Participation rate, enrollment duration, weight change, and predicted gross and net total and per capita medical expenditure savings and return on investment (ROI). ANALYSIS: Participation rate, enrollment duration, weight change, and program costs are based on direct observation. Predicted savings are simulated based on published data relating weight loss to medical expenditure reductions. RESULTS: In total, 47% of participating employees and 50% of participating dependents lost weight during the enrollment period. Mean (median) enrollment duration for employees was 7.1 months (7.0) and for dependents was 6.9 months (6.0). Mean (median) weight losses for the employees in 'Workshops' and 'Digital' was 6.6 lbs (2.80) and 6.3 lbs (0.0). For dependents, weight losses were 7.4 lbs (3.59) and 11.6 lbs (2.0). Per capita and total predicted net savings to NYC Government from employees was estimated to be $120 and $1,486,102 for an ROI of 143%. Including dependents, predicted net savings increases to $1,963,431 for an ROI of 189%. Over 80% of savings came from participants in the Obese III category. CONCLUSION: An evidence-based weight management program has the potential to generate a positive ROI for employers. Future studies should validate these estimates using actual data and more rigorous designs.


Assuntos
Gastos em Saúde , Obesidade/terapia , Sobrepeso/terapia , Programas de Redução de Peso/economia , Adulto , Análise Custo-Benefício , Medicina Baseada em Evidências , Feminino , Financiamento Governamental/economia , Apoio ao Planejamento em Saúde/organização & administração , Promoção da Saúde/economia , Promoção da Saúde/organização & administração , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Obesidade/economia , Sobrepeso/economia , Resultado do Tratamento , Programas de Redução de Peso/métodos
7.
Expert Rev Pharmacoecon Outcomes Res ; 21(2): 173-181, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33496208

RESUMO

Background: With the growing rate of obesity and associated chronic conditions in China, there is a need to assess the health and economic burdens of obesity and examine the effectiveness of pharmaceutical, medical, and comprehensive weight-loss interventions.Areas covered: This article reviewed publications retrieved from PubMed and Google Scholar during 2010-2020 on pharmacoeconomic studies related to overweight and obesity in China. We identified five cost-of-illness studies and four cost-effectiveness analyses of weight-loss interventions, including bariatric surgeries and a comprehensive intervention program.Expert opinion: There is a lack of pharmacoeconomic analyses of obesity in China. Existing studies have often taken the health system perspective without accounting for productivity loss. Cohort studies and studies based on electronic health records or claims data are needed to provide the epidemiologic parameters required for homegrown economic evaluations of the health and economic burdens of obesity in China, as well as the cost-effectiveness of interventions to reduce obesity and its sequela.


Assuntos
Efeitos Psicossociais da Doença , Farmacoeconomia , Obesidade/terapia , Cirurgia Bariátrica/economia , China , Análise Custo-Benefício , Humanos , Obesidade/economia , Redução de Peso , Programas de Redução de Peso/economia
8.
Osteoarthritis Cartilage ; 29(4): 456-470, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33197558

RESUMO

OBJECTIVE: To identify research gaps and inform implementation we systematically reviewed the literature evaluating cost-effectiveness of recommended treatments (education, exercise and diet) for the management of hip and/or knee OA. METHODS: We searched Medline, Embase, Cochrane Central Register of Controlled Trials, National Health Services Economic Evaluation Database, and EconLit from inception to November 2019 for trial-based economic evaluations investigating hip and/or knee OA core treatments. Two investigators screened relevant publications, extracted data and synthesized results. Risk of bias was assessed using the Consensus on Health Economic Criteria list. RESULTS: Two cost-minimization, five cost-effectiveness and 16 cost-utility analyses evaluated core treatments in six health systems. Exercise therapy with and without education or diet was cost-effective or cost-saving compared to education or physician-delivered usual care at conventional willingness to pay (WTP) thresholds in 15 out of 16 publications. Exercise interventions were cost-effective compared to physiotherapist-delivered usual care in three studies at conventional WTP thresholds. Education interventions were not cost-effective compared to usual care or placebo at conventional WTP thresholds in three out of four publications. CONCLUSIONS: Structured core treatment programs were clinically effective and cost-effective, compared to physician-delivered usual care, in five health care systems. Providing education about core treatments was not consistently cost-effective. Implementing structured core treatment programs into funded clinical pathways would likely be an efficient use of health system resources and enhance physician-delivered usual primary care.


Assuntos
Dietoterapia/economia , Terapia por Exercício/economia , Osteoartrite do Quadril/reabilitação , Osteoartrite do Joelho/reabilitação , Educação de Pacientes como Assunto/economia , Análise Custo-Benefício , Humanos , Osteoartrite do Quadril/economia , Osteoartrite do Joelho/economia , Programas de Redução de Peso/economia
9.
Dtsch Med Wochenschr ; 145(14): e78-e86, 2020 07.
Artigo em Alemão | MEDLINE | ID: mdl-32492722

RESUMO

BACKGROUND: The obesity treatment program "Leipziger Adipositasmanagement" is a long-term (i. e., four years long) conservative treatment program which is completely covered by a public health insurance company for patients with obesity grades 2 and 3 (i. e., body mass index > 35 kg/m2). Here we evaluate the effectiveness of the first part of the program which was on average 72 weeks long. METHODS: Body weight, body circumferences, metabolic and psychological parameters were collected prior to the start (t0) and after completion of the first part (t1). The whole first treatment part was completed by 243 persons. The analysis design was a prospective evaluation of clinical real world data. RESULTS: Treatment costs per patient were 2,022 € on average. There were significant clinically meaningful improvements from t0 to t1. On average, patients lost 5 kg (95 % confidence interval, KI 3.8 to 6.2 kg) or 4 % (KI 3.1 to 4.9 %) of their initial body weight. The hemoglobin A1c value decreased from 5.9 % to 5.6 % in all patients and from 6.7 % to 6.2 % in diabetic patients. Further metabolic (e. g., low density lipoprotein and total cholesterol) and psychological (e. g., quality of life) parameters improved significantly as well. CONCLUSIONS: The available real world data show, that an obesity treatment program, which is completely covered by a public health insurance company, can reach a clinically significant weight loss with metabolic improvements. The treatment program "Leipziger Adipositasmanagement" contributes to improving long-term treatment of obesity in Germany.


Assuntos
Obesidade/terapia , Cobertura Universal do Seguro de Saúde/economia , Programas de Redução de Peso/economia , Adulto , Complicações do Diabetes/economia , Complicações do Diabetes/psicologia , Complicações do Diabetes/terapia , Feminino , Alemanha , Hemoglobinas Glicadas/metabolismo , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/economia , Obesidade/psicologia , Estudos Prospectivos , Redução de Peso
10.
Obesity (Silver Spring) ; 28(6): 1062-1067, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32374527

RESUMO

OBJECTIVE: In traditional behavioral weight loss (BWL) programs, young adults fare worse than older adults with respect to engagement, retention, and weight loss, but money and use of technology have been cited as program factors that might improve outcomes for this population. This study evaluated young adult performance in internet-based BWL (IBWL) offering financial incentives for self-monitoring and weight loss. METHODS: Participants (N = 180; BMI = 33.2 ± 6.0 kg/m2 ) were randomly assigned to a 12-week IBWL or IBWL + incentives (IBWL + $) group. This secondary data analysis compared young adults (ages 18-35) in IBWL (n = 16) with young adults in IBWL + $ (n = 12) on percent weight loss, engagement, and retention. Young adults (n = 28) were also compared with older adults (ages 36-70; n = 152) on these outcomes. RESULTS: Young adult weight loss was -2.8% ± 5.2% in IBWL and -5.4% ± 5.7% in IBWL + $ (P = 0.23, partial η2 = 0.06). A greater proportion of young adults in IBWL + $ achieved a 10% weight loss compared with IBWL (42% vs. 6%, P = 0.02). Compared with older adults, young adults were less engaged, but there were no differences for retention or weight loss (P values > 0.05). CONCLUSIONS: Findings suggest that technology-based BWL has the potential to eliminate weight loss disparities observed between young adults and older adults in in-person BWL trials. Moreover, adding financial incentives holds promise for promoting clinically meaningful weight loss for young adults.


Assuntos
Obesidade/terapia , Reembolso de Incentivo/normas , Redução de Peso/fisiologia , Programas de Redução de Peso/economia , Adolescente , Adulto , Idoso , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Motivação , Programas de Redução de Peso/métodos , Adulto Jovem
11.
Trials ; 21(1): 139, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019609

RESUMO

BACKGROUND: A healthy lifestyle program that appeals to, and supports, obese New Zealand (NZ) European, Maori (indigenous) and Pasifika men to achieve weight loss is urgently needed. In Scotland, Football Fans in Training (FFIT), a weight management and healthy lifestyle program for overweight and obese men aged 35-65 years , delivered by community coaching staff at professional football clubs, has been shown to be beneficial and cost-effective. A pilot program inspired by FFIT but delivered by professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, improved physiological outcomes, and adherence to healthy lifestyle behaviors in overweight and obese men. The objective of this trial is to determine the effectiveness and cost-effectiveness of the Rugby Fans in Training New Zealand (RUFIT-NZ) program. METHODS: A pragmatic, two-arm, multi-center, randomized controlled trial involving 308 overweight and obese men aged 30-65 years, randomized to either an intervention group (n = 154) or a wait-list control group (n = 154). The intervention-group participated in the 12-week RUFIT-NZ program, a gender-sensitized, healthy lifestyle intervention adapted to the environment and cultural diversity of NZ and delivered through professional rugby clubs. Participants in the intervention group undergo physical training sessions, in addition to workshop-based sessions to learn about nutrition, physical activity, sleep, sedentary behavior, and a range of behavior-change strategies for sustaining a healthier lifestyle. The control group receives the program after 52 weeks. The primary outcome is change in body weight from baseline to 52 weeks. Secondary outcomes include change in body weight at 12 weeks; waist circumference, blood pressure, fitness, and lifestyle behaviors at 12 and 52 weeks; and cost-effectiveness. A process evaluation informed by the RE-AIM framework will evaluate potential implementation of RUFIT-NZ as an ongoing program in NZ after the trial. DISCUSSION: This trial will investigate the effectiveness and cost-effectiveness of the RUFIT-NZ program in overweight and obese NZ men. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered on 18 January 2019, according to the World Health Organization Trial Registration Data Set. Universal Trial Number, U1111-1245-0645.


Assuntos
Academias de Ginástica , Futebol Americano , Estilo de Vida Saudável , Estudos Multicêntricos como Assunto , Obesidade/terapia , Ensaios Clínicos Pragmáticos como Assunto , Programas de Redução de Peso/economia , Programas de Redução de Peso/métodos , Adulto , Idoso , Análise Custo-Benefício , Exercício Físico , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Comportamento Sedentário , Circunferência da Cintura , Redução de Peso
12.
Contemp Clin Trials ; 90: 105953, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32017994

RESUMO

BACKGROUND: While low-intensity Internet-delivered weight loss (IDWL) programs are efficacious, many patients fail to achieve clinically significant weight loss (WL). Given the positive association between 4-week and post-treatment WL, providing a more intensive intervention for those with sub-optimal 4-week WL may improve outcomes for a greater proportion of individuals. This stepped-care approach would minimize cost by reserving more aggressive treatment for those with sub-optimal early WL. OBJECTIVE: This randomized trial examines whether the provision of brief or extended phone coaching for those with sub-optimal early WL improves 4- and 12-month WL when compared to no coaching. Secondary aims include examination of cost/kg WL and intervention engagement. METHODS: 450 individuals (age 18-70 years, BMI: 25-45 kg/m2) will be randomized to: 1) IDWL+3 weeks of coaching ('Brief'), 2) IDWL+12 weeks of coaching ('Extended'), or 3) IDWL only ('Control'). All individuals will receive a 4-month IDWL program followed by an 8-month IDWL maintenance program. At week 4, individuals will be classified as early sub-optimal responders (<4% WL) or initial responders (≥4% WL). Individuals with sub-optimal early WL randomized to 'Brief' or 'Extended' will receive 3 and 12 weeks of phone coaching respectively, starting at week 5. Those with sub-optimal early WL randomized to 'Control', and initial responders will not receive any coaching. Assessments will occur at 4 and 12 months. DISCUSSION: Study findings can inform the development of more effective IDWL programs. This model which provides additional support to those with sub-optimal early WL can easily be translated into healthcare and community settings.


Assuntos
Internet , Tutoria/métodos , Programas de Redução de Peso/organização & administração , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Análise Custo-Benefício , Dieta , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Projetos de Pesquisa , Apoio Social , Programas de Redução de Peso/economia , Adulto Jovem
13.
Public Health Nutr ; 23(1): 83-93, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31608841

RESUMO

OBJECTIVE: We aimed to estimate the cost-effectiveness of brief weight-loss counselling by dietitian-trained practice nurses, in a high-income-country case study. DESIGN: A literature search of the impact of dietary counselling on BMI was performed to source the 'best' effect size for use in modelling. This was combined with multiple other input parameters (e.g. epidemiological and cost parameters for obesity-related diseases, likely uptake of counselling) in an established multistate life-table model with fourteen parallel BMI-related disease life tables using a 3 % discount rate. SETTING: New Zealand (NZ). PARTICIPANTS: We calculated quality-adjusted life-years (QALY) gained and health-system costs over the remainder of the lifespan of the NZ population alive in 2011 (n 4·4 million). RESULTS: Counselling was estimated to result in an increase of 250 QALY (95 % uncertainty interval -70, 560 QALY) over the population's lifetime. The incremental cost-effectiveness ratio was 2011 $NZ 138 200 per QALY gained (2018 $US 102 700). Per capita QALY gains were higher for Maori (Indigenous population) than for non-Maori, but were still not cost-effective. If willingness-to-pay was set to the level of gross domestic product per capita per QALY gained (i.e. 2011 $NZ 45 000 or 2018 $US 33 400), the probability that the intervention would be cost-effective was 2 %. CONCLUSIONS: The study provides modelling-level evidence that brief dietary counselling for weight loss in primary care generates relatively small health gains at the population level and is unlikely to be cost-effective.


Assuntos
Aconselhamento/economia , Dieta Redutora/economia , Obesidade/prevenção & controle , Enfermagem de Atenção Primária/métodos , Atenção Primária à Saúde/métodos , Adulto , Análise Custo-Benefício , Aconselhamento/métodos , Dieta Redutora/enfermagem , Feminino , Custos de Cuidados de Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Nutricionistas , Obesidade/dietoterapia , Sobrepeso/dietoterapia , Sobrepeso/prevenção & controle , Anos de Vida Ajustados por Qualidade de Vida , Redução de Peso , Programas de Redução de Peso/economia , Programas de Redução de Peso/métodos
14.
Obesity (Silver Spring) ; 28(1): 89-96, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31773873

RESUMO

OBJECTIVE: This study aimed to assess whether a counselor-initiated (CI) adaptation of the Look AHEAD (Action for Health in Diabetes) intensive lifestyle intervention in a military setting was cost-effective relative to a self-paced (SP) adaptation. METHODS: A cost-effectiveness analysis from a payer perspective was performed alongside a 2014-2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force base in Texas. Incremental cost-effectiveness ratios were calculated for weight loss, reductions in waist circumference, and quality-adjusted life-years (QALYs). RESULTS: After 12 months, the CI adaptation cost more per participant compared with the SP adaptation ($1,081 vs. $120) but achieved greater weight loss (1.86 kg vs. 0.06 kg), greater reductions in waist circumference (1.85 cm vs. 0.48 cm), and more QALYs (0.871 vs. 0.856). The incremental cost-effectiveness ratio for the CI adaptation relative to the SP adaptation was $61,268 per additional QALY. At willingness-to-pay thresholds of $50,000 and $100,000 per QALY, the CI adaptation was 45% and 49% likely to be cost-effective, respectively. CONCLUSIONS: The CI delivery of the Look AHEAD Intensive Lifestyle Intervention may offer a cost-effective approach to tackle excess weight in the US military.


Assuntos
Militares , Sobrepeso/economia , Sobrepeso/terapia , Programas de Redução de Peso/economia , Adolescente , Adulto , Análise Custo-Benefício , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Sobrepeso/epidemiologia , Aptidão Física/fisiologia , Anos de Vida Ajustados por Qualidade de Vida , Texas/epidemiologia , Estados Unidos/epidemiologia , Redução de Peso/fisiologia , Programas de Redução de Peso/métodos , Programas de Redução de Peso/estatística & dados numéricos , Adulto Jovem
15.
Obes Surg ; 30(2): 707-713, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31749107

RESUMO

BACKGROUND: Bariatric surgery remains underutilized at a national scale, and insurance company reimbursement is an important determinant of access to these procedures. We examined the current state of coverage criteria for bariatric surgery set by private insurance companies. METHODS: We surveyed medical policies of the 64 highest market share health insurance providers in the USA. ASMBS guidelines and the CMS criteria for pre-bariatric evaluation were used to collect private insurer coverage criteria, which included procedures covered, age, BMI, co-morbidities, medical weight management program (MWM), psychosocial evaluation, and a center of excellence designation. We derive a comprehensive checklist for pre-bariatric patient evaluation. RESULTS: Sixty-one companies (95%) had defined pre-authorization policies. All policies covered the RYGB, and 57 (93%) covered the LAGB or the SG. Procedures had coverage limited to center of excellence in 43% of policies (n = 26). A total of 92% required a BMI of 40 or above or of 35 or above with a co-morbidity; however, 43% (n = 23) of policies covering adolescents (n = 36) had a higher BMI requirement of 40 or above with a co-morbidity. Additional evaluation was required in the majority of policies (MWM 87%, psychosocial evaluation 75%). Revision procedures were covered in 79% (n = 48) of policies. Reimbursement of a second bariatric procedure for failure of weight loss was less frequently found (n = 41, 67%). CONCLUSIONS: A majority of private insurers still require a supervised medical weight management program prior to approval, and most will not cover adolescent bariatric surgery unless certain criteria, which are not supported by current evidence, are met.


Assuntos
Cirurgia Bariátrica/economia , Cobertura do Seguro , Seguro Saúde , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Cirurgia Bariátrica/estatística & dados numéricos , Comorbidade , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Política de Saúde/economia , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/organização & administração , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Masculino , Programas Obrigatórios/economia , Programas Obrigatórios/organização & administração , Programas Obrigatórios/estatística & dados numéricos , Pessoa de Meia-Idade , Obesidade Mórbida/economia , Obesidade Mórbida/epidemiologia , Obesidade Infantil/economia , Obesidade Infantil/epidemiologia , Obesidade Infantil/cirurgia , Reoperação/economia , Reoperação/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Redução de Peso , Programas de Redução de Peso/economia , Programas de Redução de Peso/organização & administração , Programas de Redução de Peso/estatística & dados numéricos , Adulto Jovem
16.
Appl Health Econ Health Policy ; 18(3): 351-356, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31797329

RESUMO

Since 2013, obesity services in the UK National Health Service (NHS) have focused on a tiered structure, with tiers 3 (specialist weight management services) and 4 (primarily bariatric surgery) commissioned by Clinical Commissioning Groups (CCGs) and widely reported as cost effective and recommended by national guidelines. However, CCGs have been reluctant to fully conform to the guidance. We explore how the different evaluative perspective of those generating evidence from local decision makers has contributed to this failure of the CCGs to provide services considered cost effective. We explore four elements where the conventional economic evaluation framework, as applied by the National Institute for Health and Care Excellence (NICE), differ from the reality faced by local decision makers: the cost-effectiveness threshold, the implications of decision uncertainty and budgetary excess, the valuation of future costs and outcomes, and the scope of included costs. We argue that the failure of the conventional framework to reflect the reality faced by local decision makers is rendering much of the existing literature and guidance inappropriate to the key commissioners. Our analysis demonstrates that it is not reasonable to assume that the framework of economic evaluation used to inform national guidance applies to local decision makers, such as in the commissioning of weight loss services. This failure is likely to apply to the majority of cases where evidence is generated to inform national decision makers but commissioning is at a local level.


Assuntos
Tomada de Decisões , Programas de Redução de Peso/economia , Análise Custo-Benefício , Humanos , Avaliação da Tecnologia Biomédica
17.
BMC Public Health ; 19(1): 1732, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870345

RESUMO

BACKGROUND: Finding effective intervention strategies to combat rising obesity levels could significantly reduce the burden that obesity and associated non-communicable diseases places on both individuals and the National Health Service. METHODS: In this parallel randomised-controlled trial, 76 participants who are overweight or obese (50 female) were given free access to a fitness centre for the duration of the 12-week intervention and randomised to one of three interventions. The commercial intervention, the Healthy Weight Programme, (HWP, n = 25, 10/15 men/women) consisted of twelve 1-h nutrition coaching sessions with a nutritionist delivered as a mixture of group and 1 to 1 sessions. In addition, twice-weekly exercise sessions (24 in total) were delivered by personal trainers for 12 weeks. The NHS intervention (n = 25, 8/17 men/women) consisted of following an entirely self-managed 12-week online NHS resource. The GYM intervention (n = 26, 8/18 men/women) received no guidance or formal intervention. All participants were provided with a gym induction for safety and both the NHS and GYM participants were familiarised with ACSM physical activity guidelines by way of a hand-out. RESULTS: The overall follow-up rate was 83%. Body mass was significantly reduced at post-intervention in all groups (HWP: N = 18, - 5.17 ± 4.22 kg, NHS: N = 21-4.19 ± 5.49 kg; GYM: N = 24-1.17 ± 3.00 kg; p < 0.001) with greater reductions observed in HWP and NHS groups compared to GYM (p < 0.05). Out with body mass and BMI, there were no additional statistically significant time x intervention interaction effects. CONCLUSIONS: This is the first study to evaluate the efficacy of both a free online NHS self-help weight-loss tool and a commercial weight loss programme that provides face-to-face nutritional support and supervised exercise. The findings suggest that both interventions are superior to an active control condition with regard to eliciting short-term weight-loss. TRIAL REGISTRATION: ISRCTN Registry - ISRCTN31489026. Prospectively registered: 27/07/16.


Assuntos
Obesidade/terapia , Sobrepeso/terapia , Programas de Redução de Peso/métodos , Adulto , Feminino , Humanos , Intervenção Baseada em Internet/economia , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Medicina Estatal , Reino Unido , Programas de Redução de Peso/economia , Adulto Jovem
18.
J Gen Intern Med ; 34(11): 2405-2413, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31485965

RESUMO

BACKGROUND: There is a need for new strategies to improve the success of obesity treatment within the primary care setting. OBJECTIVE: To determine if patients offered low out-of-pocket cost weight management tools achieved more weight loss compared to usual care. DESIGN: Twelve-month pragmatic clinical weight loss trial with a registry-based comparator group performed in primary care clinics of an urban safety-net hospital. PARTICIPANTS: From a large clinical registry, we randomly selected 428 patients to have the opportunity to receive the intervention. INTERVENTIONS: Medical weight management tools-partial meal replacements, recreation center vouchers, pharmacotherapy, commercial weight loss program vouchers, and a group behavioral weight loss program-for $5 or $10 monthly. Patients chose their tools, could switch tools, and could add a second tool at 6 months. MAIN MEASURES: The primary outcome was the proportion of intervention-eligible patients who achieved ≥ 5% weight loss. The main secondary outcome was the proportion of on-treatment patients who achieved ≥ 5% weight loss. KEY RESULTS: Overall, 71.3% (305 of 428) had available weight measurement data/PCP visit data to observe the primary outcome. At 12 months, 23.3% (71 of 305) of intervention-eligible participants and 15.7% (415 of 2640) of registry-based comparators had achieved 5% weight loss (p < 0.001). Of the on-treatment participants, 34.5% (39 of 113) achieved 5% weight loss. Mean percentage weight loss was - 3.15% ± 6.41% for on-treatment participants and - 0.30% ± 6.10% for comparators (p < 0.001). The initially preferred tools were meal replacements, pharmacotherapy, and recreation center passes. CONCLUSIONS: Access to a variety of low out-of-pocket cost weight management tools within primary care resulted in ≥ 5% body weight loss in approximately one quarter of low-income patients with obesity. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01922934.


Assuntos
Obesidade/terapia , Programas de Redução de Peso/métodos , Adulto , Terapia Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Provedores de Redes de Segurança/métodos , Provedores de Redes de Segurança/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Redução de Peso , Programas de Redução de Peso/economia
19.
BMC Public Health ; 19(1): 739, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196026

RESUMO

BACKGROUND: Beginning in 2017 we have conducted a 3-arm randomised controlled trial (RCT) to determine the effectiveness of an early obesity intervention in the first two years of life using either telephone or Short Message Service (SMS) support for mothers. The trial recruited 1155 mothers from their third trimester of pregnancy. This protocol is for a new trial to build on the existing trial using the mother-child dyads retained at 24 months for recruitment to the new RCT. The aim of this new trial is to test whether use of a combination of telephone and SMS interventions is effective in promoting healthy eating and physical activity, as well as reducing child body mass index (BMI) at 3 years of age. METHODS: We will conduct a parallel RCT with an estimated sample of 750 mother-child dyads retained from the existing trial at 24 months. Mothers who completed the 24 months survey, including a telephone survey and measurement of child's height and weight will be invited to participate in the new trial. Informed consent will be obtained at the 24 months survey. The participating mother-child dyads will then be randomly allocated to the intervention (combined telephone and text messaging intervention) or the control group. The intervention will comprise three staged telephone consultations and text messages after each of the three intervention booklets is mailed to mothers at specific time-points between two and three years of child age. The main trial outcome measures include a) BMI and BMI z-score measured at 36 months, b) diet, physical activity and screen time c) cost-effectiveness, and d) feasibility and acceptability of the intervention. DISCUSSION: This unique opportunity to link two studies will expedite project start up time, utilise existing research infrastructure and systems to run the study, and optimise the use of an already engaged population of study participants. It can address a significant knowledge gap regarding early obesity prevention for children aged 2 to 3 years. The feasibility and effectiveness of the combined telephone and SMS intervention will indicate whether this is a scaleable, broad-reach and low-cost early obesity intervention. TRIAL REGISTRATION: The trial was registered with the Australian Clinical Trial Registry ( ACTRN12618001571268 ) on 20/09/2018.


Assuntos
Obesidade Infantil/prevenção & controle , Programas de Redução de Peso/métodos , Programas de Redução de Peso/organização & administração , Austrália , Índice de Massa Corporal , Pré-Escolar , Análise Custo-Benefício , Dieta Saudável , Exercício Físico , Estudos de Viabilidade , Feminino , Humanos , Masculino , Relações Mãe-Filho , Mães/psicologia , Gravidez , Avaliação de Programas e Projetos de Saúde , Telefone , Envio de Mensagens de Texto , Programas de Redução de Peso/economia
20.
Acad Pediatr ; 19(7): 764-772, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31128381

RESUMO

OBJECTIVE: To examine parents' interest in continuing and willingness to pay (WTP) for 2 pediatric weight management programs following their participation. METHODS: Participants were parents of 2- to 12-year-old children with body mass index ≥ 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other received EPC plus individualized coaching (EPC+C). At 1 year, we assessed parents' self-reported WTP for a similar program and the maximum amount ($/month) they would pay. We used multivariable regression to examine differences in WTP and WTP amount by intervention arm and by individual and family-level factors. RESULTS: Of 638 parents who completed the survey, 85% were interested in continuing and 38% of those parents were willing to pay (31% in the EPC group and 45% in the EPC+C group). The median amount parents were willing to pay was $25/month (interquartile range, $15-$50). In multivariable models, the EPC+C parents were more likely to endorse WTP than the EPC parents (odds ratio, 1.53; 95% confidence interval, 1.05-2.22). Parents of children with Hispanic/Latino versus white ethnicity and those reporting higher satisfaction with the program were also more likely to endorse WTP. CONCLUSIONS: Most parents of children in a weight management program were interested in continuing it after it ended, but fewer were willing to pay out of pocket for it. A greater proportion of parents were willing to pay if the program included individualized health coaching.


Assuntos
Gastos em Saúde , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Obesidade Infantil/terapia , Programas de Redução de Peso/economia , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Inquéritos e Questionários , Volição
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