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

Authors

• Ping Zhang, Centers for Disease Control and Prevention, Atlanta, GA paz2@cdc.gov.
• Karen M. Atkinson, VA Puget Sound Health Care System and University of Washington, Seattle, WA.
• George A. Bray, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.Follow
• Haiying Chen, Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
• Jeanne M. Clark, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
• Mace Coday, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN.
• Gareth R. Dutton, Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL.
• Caitlin Egan, Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI.
• Mark A. Espeland, Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
• Mary Evans, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
• John P. Foreyt, Department of Medicine, Baylor College of Medicine, Houston, TX.Follow
• Frank L. Greenway, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.
• Edward W. Gregg, Department of Epidemiology and Biostatistics, Imperial College London, London, U.K.
• Helen P. Hazuda, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX.
• James O. Hill, Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL.
• Edward S. Horton, Department of Medicine, Joslin Diabetes Center, Boston, MA.
• Van S. Hubbard, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
• Peter J. Huckfeldt, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN.
• Sharon D. Jackson, Department of Medicine, Joslin Diabetes Center, Boston, MA.
• John M. Jakicic, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA.Follow
• Robert W. Jeffery, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.Follow
• Karen C. Johnson, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN.
• Steven E. Kahn, VA Puget Sound Health Care System and University of Washington, Seattle, WA.Follow
• Tina Killean, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.Follow
• William C. Knowler, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.
• Mary Korytkowski, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
• Cora E. Lewis, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.Follow
• Nisa M. Maruthur, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
• Sara Michaels, Indian Health Service, Shiprock, NM.
• Maria G. Montez, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX.
• David M. Nathan, Diabetes Research Center, Massachusetts General Hospital, Boston, MA.
• Jennifer Patricio, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY.
• Anne Peters, Houston Methodist Research Institute, Baylor College of Medicine, Houston, TX.

Abstract

OBJECTIVE: To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared with 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 their first 9 years of study participation from 2001 to 2012. Information on Health Utilities Index Mark 2 (HUI-2) and HUI-3, Short-Form 6D (SF-6D), and Feeling Thermometer (FT), cost of delivering the interventions, and health expenditures was collected during the study. CE was measured by incremental CE ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 U.S. dollars. RESULTS: Over the 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 0.07 and 0.15, 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.

Publication Title

Diabetes care

Recommended Citation

Zhang, Ping; Atkinson, Karen M.; Bray, George A.; Chen, Haiying; Clark, Jeanne M.; Coday, Mace; Dutton, Gareth R.; Egan, Caitlin; Espeland, Mark A.; Evans, Mary; Foreyt, John P.; Greenway, Frank L.; Gregg, Edward W.; Hazuda, Helen P.; Hill, James O.; Horton, Edward S.; Hubbard, Van S.; Huckfeldt, Peter J.; Jackson, Sharon D.; Jakicic, John M.; Jeffery, Robert W.; Johnson, Karen C.; Kahn, Steven E.; Killean, Tina; Knowler, William C.; Korytkowski, Mary; Lewis, Cora E.; Maruthur, Nisa M.; Michaels, Sara; Montez, Maria G.; Nathan, David M.; Patricio, Jennifer; and Peters, Anne, "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" (2021). Loewenberg College of Nursing Faculty Publications. 167.
https://digitalcommons.memphis.edu/lcon-facpubs/167