Stanford Health Policy Group, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, California, USA.
Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, USA.
Obesity (Silver Spring). 2020 Jun;28(6):1031-1039. doi: 10.1002/oby.22805. Epub 2020 Apr 22.
Obesity and depression are prevalent and often co-occurring conditions in the United States. The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized trial demonstrated the effectiveness of an integrated intervention for adults with both conditions. Characterizing the intervention's economic effects is important for broader dissemination and implementation.
This study evaluated the cost (2018 US dollars) and health-related quality of life (HRQoL) impacts during RAINBOW's first year, comparing intervention (n = 204) and usual-care groups (n = 205). Outcomes included intervention delivery costs, differential changes in antidepressant medication spending compared with the pretrial year, differential changes in medical services spending compared with the pretrial year, and HRQoL changes from baseline using Euroqol-5D US utility weights.
RAINBOW's 1-year delivery cost per person was $2,251. Compared with usual care, annual antidepressant medication days increased more (38 days [95% CI: 4 to 72]; P = 0.027). Annual antidepressant medication spending had a larger, nonsignificant increase ($89 [95% CI: -$20 to $197]; P = 0.109). Annual spending on medical care services had a smaller, nonsignificant decrease (-$54 [95% CI: -$832 to $941]; P = 0.905). HRQoL had a nonsignificant increase (0.011 [95% CI: -0.025 to 0.047]; P = 0.546).
The RAINBOW intervention's economic value will depend on how its 1-year improvements in obesity and depression translate into long-term reduced morbidity, delayed mortality, or averted costs.
肥胖和抑郁在美国普遍存在且常同时发生。旨在改善情绪和体重的研究（RAINBOW）随机试验证明了针对这两种疾病的综合干预措施的有效性。描述干预措施的经济效果对于更广泛的传播和实施很重要。
本研究评估了 RAINBOW 第一年的成本（2018 年美元）和健康相关生活质量（HRQoL）影响，比较了干预组（n=204）和常规护理组（n=205）。结果包括干预交付成本、与 pretrial年相比抗抑郁药物支出的差异变化、与 pretrial年相比医疗服务支出的差异变化，以及使用 Euroqol-5D US 效用权重从基线的 HRQoL 变化。
RAINBOW 每人每年的交付成本为 2251 美元。与常规护理相比，年度抗抑郁药物天数增加更多（38 天[95%CI：4 至 72]；P=0.027）。年度抗抑郁药物支出有更大但无统计学意义的增加（89 美元[95%CI：-20 至 197]；P=0.109）。医疗服务年度支出有较小但无统计学意义的减少（-54 美元[95%CI：-832 至 941]；P=0.905）。HRQoL 无统计学意义的增加（0.011[95%CI：-0.025 至 0.047]；P=0.546）。
RAINBOW 干预的经济价值将取决于其在肥胖和抑郁方面的 1 年改善如何转化为长期减少发病率、延迟死亡率或避免成本。
