A randomised controlled trial to test the clinical and cost-effectiveness of primary care referral to a commercial weight loss provider.

一项随机对照试验，旨在测试初级保健转介给商业减肥提供商的临床和成本效益。

• 批准号: MC_EX_MR/J000493/1
• 负责人: Amy Ahern
• 金额: $ 115.54万
• 依托单位: MRC Centre Cambridge
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2012
• 资助国家: 英国
• 起止时间: 2012 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MC_EX_MR%2FJ000493%2F1
• 关键词: randomised; controlled; trial; test; clinical

Overweight and obesity is a serious public health issue due to its high prevalence and association with illnesses, such as Type II diabetes, heart disease and cancer. Early treatment and prevention are important if we are to reduce the health problems associated with excess weight, but there are few treatments available through the National Health Service (NHS) and those that are available can be very costly when we consider the number of people requiring treatment. It is in the interests of the NHS to offer (cost-effective) weight loss treatment options, as they spend £4.2 billion each year on treating illness related to overweight and obesity. The cost to the wider community is estimated at £16 billion. This study seeks to examine one of the treatment options currently available on the NHS - referral to a commercial weight loss treatment provider - and to establish whether this treatment option is cost-effective in helping people to lose weight and keep it off. Previous research has shown that referring a patient for 12 sessions with a commercial weight loss provider can produce an amount of weight loss which has significant health benefits. These referral packages are offered to the NHS at a discounted price, however no studies have formally evaluated the cost-effectiveness of this approach. This study will examine whether the money spent on treatment is worthwhile when we consider the effect of improved health for patients and also potential cost savings on treatments for weight-related illness. But weight regain is common after weight loss treatment stops and it may be that 12 weeks is not long enough to develop long term changes in behaviour. It is not hard to imagine that a 12 month referral could lead to greater weight loss and more long term changes than a 12 week programme, and that this could mean less weight regain. However, the likely increased effect will come at a higher cost, leaving the question 'What is the more cost-effective option?'. This is precisely what this study seeks to examine. We also want to uderstand more about the patient experience of weight loss treatment. Previous research has shown that many adults with overweight and obesity do not consider this to be a medical problem and this may influence their attitudes to receiving treatment through the NHS. By improving our understanding of attitudes and experience of treatment, we can improve the way weight management is provided by the NHS.In our trial, 1200 adults with overweight and obesity will be identified by their GP and recruited by the research team. The research team will randomly assign participants to one of three treatment groups - a 12 session referral to a commercial provider, a 12 month referral to a commercial provider, or a 'brief intervention' (standard information about how to lose weight and weighing at follow up). We will follow participants up at 3 months, 12 months and 24 months (1 year after treatment has finished) to compare the amount of weight lost by participants in each group. We will also look at how many participants in each group lose an amount of weight that is associated with significant health improvements. We will use this and other data collected during the trial to examine which treatment option offers the best value for money. This will be examined over the short term (the duration of the trial) and the longer term, using long term modelling of anticipated health changes and associated costs. We will also interview a subset of participants to gain a more holistic view of the patient experience and to explore their attitudes to weight loss treatment and NHS-commercial partnerships.This research will provide important information to GPs and NHS treatment commissioners about which treatment option is most effective and which offers best value for money. Trial results and findings from interviews will help inform future decisions about NHS-commercial partnership

超重和肥胖是一个严重的公共卫生问题，因为它的高流行率和与疾病的关联，如II型糖尿病，心脏病和癌症。如果我们要减少与超重相关的健康问题，早期治疗和预防是很重要的，但是通过国家卫生服务（NHS）提供的治疗很少，当我们考虑到需要治疗的人数时，现有的治疗可能非常昂贵。提供（具有成本效益的）减肥治疗方案符合NHS的利益，因为他们每年花费42亿英镑用于治疗与超重和肥胖有关的疾病。整个社区的成本估计为160亿英镑。这项研究旨在检查NHS目前提供的治疗方案之一-转介给商业减肥治疗提供者-并确定这种治疗方案在帮助人们减肥和保持体重方面是否具有成本效益。先前的研究表明，将患者转介给商业减肥提供者进行12次治疗可以产生一定量的减肥效果，这对健康有显着的好处。这些转介包以折扣价提供给NHS，但没有研究正式评估这种方法的成本效益。这项研究将探讨当我们考虑到改善患者健康的效果以及治疗体重相关疾病的潜在成本节省时，花在治疗上的钱是否值得。但体重反弹是常见的减肥治疗停止后，它可能是12周是不够长的时间来发展长期的行为变化。不难想象，12个月的转诊可能会比12周的计划带来更大的体重减轻和更长期的变化，这可能意味着更少的体重反弹。然而，可能增加的效果将带来更高的成本，留下的问题是“什么是更具成本效益的选择？”'.这正是本研究报告试图探讨的问题。我们还想了解更多关于患者的减肥治疗经验。先前的研究表明，许多超重和肥胖的成年人不认为这是一个医疗问题，这可能会影响他们通过NHS接受治疗的态度。通过提高我们对态度和治疗经验的理解，我们可以改善NHS提供的体重管理方式。在我们的试验中，1200名超重和肥胖的成年人将由他们的全科医生确定，并由研究小组招募。研究小组将参与者随机分配到三个治疗组中的一个-12个疗程转介到商业提供者，12个月转介到商业提供者，或“简短干预”（有关如何减肥和随访时体重的标准信息）。我们将在3个月，12个月和24个月（治疗结束后1年）对参与者进行随访，以比较每组参与者的体重减轻量。我们还将研究每组中有多少参与者减轻了与显著健康改善相关的体重。我们将使用这些数据和试验期间收集的其他数据来检查哪种治疗方案提供最佳性价比。这将在短期（试验持续时间）和长期内进行检查，使用预期健康变化和相关成本的长期模型。我们还将采访一部分参与者，以获得对患者体验的更全面的看法，并探讨他们对减肥治疗和NHS商业伙伴关系的态度。这项研究将为全科医生和NHS治疗专员提供重要信息，了解哪种治疗方案最有效，哪种治疗方案最物有所值。试验结果和采访结果将有助于为未来关于NHS商业伙伴关系的决定提供信息

项目成果

Experiences of a commercial weight-loss programme after primary care referral: a qualitative study.

• DOI: 10.3399/bjgp15x684409
• 发表时间: 2015-04
• 期刊: The British journal of general practice : the journal of the Royal College of General Practitioners
• 作者: Allen JT;Cohn SR;Ahern AL
• 通讯作者: Ahern AL

Cross-model validation of public health microsimulation models; comparing two models on estimated effects of a weight management intervention

• DOI: 10.1186/s12889-024-18134-4
• 发表时间: 2024-03-12
• 期刊: BMC PUBLIC HEALTH
• 影响因子: 4.5
• 作者: Bates，Sarah;Breeze，Penny;Brennan，Alan
• 通讯作者: Brennan，Alan

Inequalities in the uptake of weight management interventions in a pragmatic trial: an observational study in primary care.

• DOI: 10.3399/bjgp16x684337
• 发表时间: 2016-04
• 期刊: The British journal of general practice : the journal of the Royal College of General Practitioners
• 作者: Ahern AL;Aveyard P;Boyland EJ;Halford JC;Jebb SA;WRAP trial team
• 通讯作者: WRAP trial team

OP49 Association between indicators of inequality and weight regain following a behavioural weight loss intervention

OP49 行为减肥干预后不平等指标与体重恢复之间的关联

• DOI: 10.1136/jech-2022-ssmabstracts.48
• 发表时间: 2022
• 作者: Birch J

Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial.

• DOI: 10.1016/s0140-6736(17)30647-5
• 发表时间: 2017-06-03
• 期刊: Lancet (London, England)
• 作者: Ahern AL;Wheeler GM;Aveyard P;Boyland EJ;Halford JCG;Mander AP;Woolston J;Thomson AM;Tsiountsioura M;Cole D;Mead BR;Irvine L;Turner D;Suhrcke M;Pimpin L;Retat L;Jaccard A;Webber L;Cohn SR;Jebb SA
• 通讯作者: Jebb SA