Comparing Behavioral Weight Loss Modalities: Incremental Cost-Effectiveness of an Internet-Based Versus an In-Person Condition
Comparing Behavioral Weight Loss Modalities: Incremental Cost-Effectiveness of an Internet-Based Versus an In-Person Condition
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DOI：
10.1038/oby.2010.341
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发表时间：
2011-08-01
期刊：
影响因子：
6.9
通讯作者：
West, Delia S.
中科院分区：
文献类型：
--
作者：
Krukowski, Rebecca A.;Tilford, J. Mick;West, Delia S.
本研究的目的是评估与群体行为减肥干预相关的成本，并比较基于治疗交付方式（面对面与互联网）的成本效益。一项随机对照试验检验了面对面和网络治疗方式对群体行为肥胖干预的效果。来自两个中心的参与者（N = 323, 93%为女性，平均BMI = 35.8）被随机分配到治疗方式，并在不同条件下匹配接触时间。主要结果是体重减轻。成本效益指标基于超额生命损失年数（YLL）算法和两种模式的成本，计算6个月时体重变化带来的生命增加年数（LYG）。面对面参与者的体重减轻（-8.0 +/- 6.1 kg）明显大于互联网参与者（-5.5 +/- 5.6 kg），而LYG的差异不显著。在面对面和网络条件下，估计LYG分别为0.58（95%置信区间：0.45,0.71）和0.47（95%置信区间：0.34,0.60）。进行面对面测试的总成本为每人706美元，互联网测试的总成本为每人372美元，差异主要是由于每人的旅行成本增加了158美元。相对于不干预或不减肥，网络方式的增量成本-效果比为2160美元/小时（折后），面对面方式相对于网络方式的增量成本-效果比为7177美元/小时（折后）。参与者时间成本被认为是医疗和行为干预的一项重要成本。当参与者的时间成本被纳入行为减肥干预的经济评估时，基于互联网的减肥交付可能是一种更具成本效益的肥胖治疗方法。
The objective of this study was to assess the costs associated with a group behavioral weight loss intervention and compare cost-effectiveness based on treatment delivery modality (in-person vs. Internet). A randomized controlled trial examined efficacy of a group behavioral obesity intervention across in-person and Internet treatment modalities. Participants (N = 323, 93% women, mean BMI = 35.8) from two centers were randomized to treatment modality, and contact time was matched between conditions. Primary outcome was weight loss. Cost-effectiveness measures calculated life years gained (LYG) from changes in weight at 6 months, based on excess years of life lost (YLL) algorithm and the cost of the two modalities. In-person participants had significantly greater weight losses (-8.0 +/- 6.1 kg) than Internet participants (-5.5 +/- 5.6 kg), whereas differences in LYG were insignificant. Estimated LYG was 0.58 (95% confidence interval: 0.45, 0.71) and 0.47 (95% confidence interval: 0.34, 0.60) for the in-person and Internet condition, respectively. Total cost of conducting the in-person condition was $706 per person and the Internet condition was $372 per person with the difference mainly due to increased travel cost of $158 per person. The incremental cost-effectiveness ratio was $2,160 per (discounted) LYG for the Internet modality relative to no intervention/no weight loss and $7,177 per (discounted) LYG for the in-person modality relative to the Internet modality. Participant time costs are recognized as an important cost of medical and behavioral interventions. When participant time costs are included in an economic evaluation of a behavioral weight loss intervention, Internet-based weight loss delivery may be a more cost-effective approach to obesity treatment.