Gussenhoven A H M, van Wier M F, Bosmans J E, Dekkers J C, van Mechelen W
Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.
Work. 2013 Jan 1;46(3):337-46. doi: 10.3233/WOR-121555.
The objective of this study was to determine whether a lifestyle intervention with individual counselling was cost-effective for reducing body weight compared with usual care from a company perspective.
Overweight employees were recruited and randomly assigned to the intervention groups, either phone or Internet, or the control group.
The intervention was based on a cognitive behavioural approach and addressed physical activity and diet. Self-reported body weight was collected at baseline and 12 months follow-up. Intervention costs and costs of sick leave days based on gross and net lost productivity days (GLPDs/NLPDs) obtained from the participating companies were calculated. Missing data were imputed using multiple imputation techniques. Uncertainty surrounding the differences in costs and the incremental cost-effectiveness ratios (ICER) was estimated by bootstrapping techniques, and presented on cost-effectiveness planes and cost-effectiveness acceptability curves.
No statistically significant differences in total costs were found between the intervention groups and control group, though mean total costs in both intervention groups tended to be higher than those in the control group. The ICER of the Internet group compared with the control group was €59 per kilogram of weight loss based on GLPD costs. The probability of cost effectiveness of the Internet intervention was 45% at a willingness-to-pay of €0 per extra kilogram weight loss and 75% at a willingness-to-pay of €1500 per extra kilogram body weight loss. Comparable results were found for the phone intervention.
The intervention was not cost effective in comparison with usual care from the company perspective. Due to the large amount of missing data, it is not possible to draw firm conclusions.
本研究的目的是从公司角度确定与常规护理相比，采用个体咨询的生活方式干预在减轻体重方面是否具有成本效益。
招募超重员工并将其随机分配到干预组（电话或互联网干预组）或对照组。
干预基于认知行为方法，涉及身体活动和饮食。在基线和随访12个月时收集自我报告的体重。计算干预成本以及根据参与公司提供的总损失生产力天数和净损失生产力天数得出的病假天数成本。使用多重插补技术对缺失数据进行插补。通过自抽样技术估计成本差异和增量成本效益比（ICER）的不确定性，并在成本效益平面和成本效益可接受性曲线上呈现。
干预组和对照组之间在总成本上未发现统计学上的显著差异，不过两个干预组的平均总成本往往高于对照组。基于总损失生产力天数成本，互联网干预组与对照组相比，每减轻1千克体重的ICER为59欧元。在每额外减轻1千克体重支付意愿为0欧元时，互联网干预具有成本效益的概率为45%；在每额外减轻1千克体重支付意愿为1500欧元时，该概率为75%。电话干预也得到了类似结果。
从公司角度来看，与常规护理相比，该干预不具有成本效益。由于存在大量缺失数据，无法得出确凿结论。
