Meads D M, Hulme C T, Hall P, Hill A J
Academic Unit of Health Economics, University of Leeds, Leeds, UK.
Clin Obes. 2014 Dec;4(6):324-32. doi: 10.1111/cob.12077.
Primary care referral to commercial weight loss programmes that follow best practice is included in current UK guidance on the management of adult obesity. This study investigated whether such a programme was cost-effective compared with usual care. A decision-analytical Markov model was developed to estimate the lifetime costs and benefits of the referral programme compared with usual care and enable a cost-utility analysis. The model cohort transited between body mass index classifications and type 2 diabetes, stroke and myocardial infarction (MI) with risk, cost and effect parameter values taken from published literature. The cost per incremental quality-adjusted life year (QALY) was calculated. Extensive deterministic and scenario sensitivity analyses and probabilistic sensitivity analyses (PSA) were conducted. At 12 months, the incremental cost-effectiveness ratio was £6906, indicating that programme referral was cost-effective. Over a lifetime, referral to the commercial programme was dominant as it led to a cost saving of £924 and conferred incremental benefit (0.22 QALY) over usual care. Model simulations estimated lower lifetime rates of type 2 diabetes, stroke and MI as a result of the weight loss achieved. The results were robust to extensive sensitivity analyses. The PSA indicated that programme referral had a 68% chance of being cost-effective at a willingness to pay per incremental QALY threshold of £20,000. Referral to the programme dominated usual care, being both cheaper and more effective. These results compare favourably with economic evaluations of other obesity interventions and add to a growing evidence base on the cost-effectiveness of commercial weight loss providers and practices.
将初级护理转诊至遵循最佳实践的商业减肥项目，这一做法包含在英国当前关于成人肥胖管理的指南中。本研究调查了与常规护理相比，这样一个项目是否具有成本效益。我们开发了一个决策分析马尔可夫模型，以估计该转诊项目与常规护理相比的终身成本和效益，并进行成本效用分析。模型队列在体重指数分类以及2型糖尿病、中风和心肌梗死（MI）之间转变，风险、成本和效果参数值取自已发表的文献。计算了每增加一个质量调整生命年（QALY）的成本。进行了广泛的确定性和情景敏感性分析以及概率敏感性分析（PSA）。在12个月时，增量成本效益比为6906英镑，表明项目转诊具有成本效益。在一生中，转诊至商业项目占主导地位，因为它导致节省了924英镑的成本，并比常规护理带来了增量效益（0.22 QALY）。模型模拟估计，由于实现了体重减轻，2型糖尿病、中风和MI的终身发病率较低。结果在广泛的敏感性分析中具有稳健性。PSA表明，在每增加一个QALY的支付意愿阈值为20000英镑时，项目转诊有68%的可能性具有成本效益。转诊至该项目优于常规护理，既更便宜又更有效。这些结果与其他肥胖干预措施的经济评估相比具有优势，并为商业减肥服务提供商和做法的成本效益提供了越来越多的证据基础。
