Screening and brief intervention for obesity in primary care: cost-effectiveness analysis in the BWeL trial

Lise Retat, Laura Pimpin, Laura Webber, Abbygail Jaccard, Amanda Lewis, Sarah Tearne, Kathryn Hood, Anna Christian-Brown, Peymane Adab, Rachna Begh, Kate Jolly, Amanda Daley, Amanda Farley, Deborah Lycett, Alecia Nickless, Ly-Mee Yu, Susan Jebb, Paul Aveyard

Research output: Contribution to journalArticle

4 Citations (Scopus)
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Abstract

Background
The Brief Intervention for Weight Loss Trial enrolled 1882 consecutively attending primary care patients who were obese and participants were randomised to physicians opportunistically endorsing, offering, and facilitating a referral to a weight loss programme (support) or recommending weight loss (advice). After one year, the support group lost 1.4kg more (95%CI 0.9 to 2.0): 2.4 kg versus 1.0 kg. We use a cohort simulation to predict effects on disease incidence, quality of life, and healthcare costs over 20 years.

Methods
Randomly sampling from the trial population, we created a virtual cohort of 20 million adults and assigned baseline morbidity. We applied the weight loss observed in the trial and assumed weight regain over four years. Using epidemiological data, we assigned the incidence of 12 weight-related diseases depending on baseline disease status, age, gender, body mass index. From a healthcare perspective, we calculated the quality adjusted life years (QALYs) accruing and calculated the incremental difference between trial arms in costs expended in delivering the intervention and healthcare costs accruing. We discounted future costs and benefits at 1.5% over 20 years.

Results
Compared with advice, the support intervention reduced the cumulative incidence of weight-related disease by 722/100,000 people, 0.33% of all weight-related disease. The incremental cost of support over advice was £2.01million/100,000. However, the support intervention reduced health service costs by £5.86 million/100,000 leading to a net saving of £3.85 million/100,000. The support intervention produced 992 QALYs/100,000 people relative to advice.

Conclusions
A brief intervention in which physicians opportunistically endorse, offer, and facilitate a referral to a behavioural weight management service to patients with a BMI of at least 30kg/m2 reduces healthcare costs and improves health more than advising weight loss.
Original languageEnglish
Pages (from-to)2066-2075
Number of pages10
JournalInternational Journal of Obesity
Volume43
Issue number10
Early online date31 Jan 2019
DOIs
Publication statusPublished - Oct 2019

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Bibliographical note

The final publication is available at Springer via http://dx.doi.org/10.1038/s41366-018-0295-7

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ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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