School of Population Health, The University of Queensland, Herston, QLD 4006, Australia.
Aust N Z J Public Health. 2010 Jun;34(3):240-7. doi: 10.1111/j.1753-6405.2010.00520.x.
Intensive weight loss programs that incorporate dietary counselling and exercise advice are popular and are supported by evidence of immediate weight loss benefits. We evaluate the cost-effectiveness of two weight loss programs, Lighten Up to a Healthy Lifestyle and Weight Watchers.
Health gains from prevention of chronic disease are modelled over the lifetime of the Australian population. These results are combined with estimates of intervention costs and cost offsets (due to reduced rates of lifestyle-related diseases) to determine the dollars per disability-adjusted life year (DALY) averted by each intervention program, from an Australian health sector perspective.
Both weight loss programs produced small improvements in population health compared to current practice. The time and travel associated with attending group-counselling sessions, however, was costly for patients, and overall the cost-effectiveness ratios for Lighten Up ($130,000/DALY) and Weight Watchers ($140,000/DALY) were high.
Based on current evidence, these intensive behavioural counselling interventions are not very cost-effective strategies for reducing obesity, and the potential benefits for population health are small.
It will be critical to consider other strategies (e.g. changing the 'obesogenic' environment) or explore alternative methods of intervention delivery (e.g. Internet) to see if they offer a more cost-effective approach by effectively reaching a high number of people at a low cost.
结合饮食咨询和运动建议的强化减肥方案广受欢迎,并且有即时减肥效果的证据支持。我们评估了两种减肥方案(Lighten Up to a Healthy Lifestyle 和 Weight Watchers)的成本效益。
通过对澳大利亚人口的终生进行建模,预测预防慢性病带来的健康收益。将这些结果与干预成本和成本节约(由于生活方式相关疾病的发病率降低)的估计值结合起来,从澳大利亚卫生部门的角度来确定每个干预方案避免每例残疾调整生命年(DALY)的费用。
与当前的实践相比,这两种减肥方案都能使人群健康状况略有改善。然而,参加小组咨询会议所花费的时间和交通费用对患者来说是昂贵的,Lighten Up(130,000 澳元/DALY)和 Weight Watchers(140,000 澳元/DALY)的成本效益比均较高。
基于现有证据,这些强化行为咨询干预措施对于减少肥胖并不是非常具有成本效益的策略,对人群健康的潜在收益较小。
至关重要的是,需要考虑其他策略(例如改变“致肥胖环境”)或探索替代的干预措施(例如互联网),以确定它们是否以较低的成本有效地覆盖大量人群,从而提供更具成本效益的方法。