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
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.
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.