Centre for Health Economics, Monash University, Melbourne, Victoria, Australia.
Nutr Diabetes. 2013 Jun 24;3(6):e77. doi: 10.1038/nutd.2013.18.
Pre-commitment strategies can encourage participants to commit to a healthy food plan and have been suggested as a potential strategy for weight loss. However, it is unclear whether such strategies are cost-effective.
To analyse whether pre-commitment interventions that facilitate healthier diets are a cost-effective approach to tackle obesity.
Effectiveness evidence was obtained from a systematic review of the literature. For interventions demonstrating a clinically significant change in weight, a Markov model was employed to simulate the long-term health and economic consequences. The review supported modelling just one intervention: grocery shopping to a predetermined list combined with standard behavioural therapy (SBT). SBT alone and do nothing were used as comparators. The target population was overweight or obese adult women. A lifetime horizon for health effects (expressed as quality-adjusted life years (QALYs)) and costs from the perspective of the UK health sector were used to calculate incremental cost-effectiveness ratios (ICERs).
In the base case analysis, the pre-commitment strategy of shopping to a list was found to be more effective and cost saving when compared against SBT, and cost-effective when compared against 'do nothing' (ICER=£166 per QALY gained). A sensitivity analysis indicated that shopping to a list remained dominant or cost-effective under various scenarios.
Our findings suggest grocery shopping to a predetermined list combined with SBT is a cost-effective means for reducing obesity and its related health conditions.
预承诺策略可以鼓励参与者承诺执行健康的饮食计划，被认为是一种潜在的减肥策略。然而，目前尚不清楚这些策略是否具有成本效益。
分析促进更健康饮食的预承诺干预措施是否是解决肥胖问题的一种具有成本效益的方法。
从文献系统评价中获得有效性证据。对于体重有临床显著变化的干预措施，采用马尔可夫模型模拟长期的健康和经济后果。本综述支持仅对一种干预措施进行建模：根据预定清单购物并结合标准行为疗法（SBT）。仅 SBT 和不采取任何措施被用作对照。目标人群是超重或肥胖的成年女性。从英国卫生部门的角度来看，使用健康效果的终生（以质量调整生命年（QALY）表示）和成本来计算增量成本效益比（ICER）。
在基本情况下的分析中，与 SBT 相比，购物清单的预承诺策略更有效且节省成本，与“不作为”相比也具有成本效益（每获得一个 QALY 的增量成本为 166 英镑）。敏感性分析表明，在各种情况下，购物清单仍然具有优势或具有成本效益。
我们的研究结果表明，根据预定清单购物并结合 SBT，是一种降低肥胖及其相关健康状况的具有成本效益的方法。
