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Randomized Controlled Trial
. 2019 Oct;43(10):2066-2075.
doi: 10.1038/s41366-018-0295-7. Epub 2019 Jan 31.

Screening and brief intervention for obesity in primary care: cost-effectiveness analysis in the BWeL trial

Lise Retat  1 , Laura Pimpin  1 , Laura Webber  1 , Abbygail Jaccard  1 , Amanda Lewis  2 , Sarah Tearne  3 , Kathryn Hood  2 , Anna Christian-Brown  3 , Peymane Adab  4 , Rachna Begh  3 , Kate Jolly  4 , Amanda Daley  5 , Amanda Farley  4 , Deborah Lycett  6 , Alecia Nickless  3 , Ly-Mee Yu  3 , Susan Jebb  3 , Paul Aveyard  7
Affiliations
Randomized Controlled Trial

Screening and brief intervention for obesity in primary care: cost-effectiveness analysis in the BWeL trial

Lise Retat et al. Int J Obes (Lond). 2019 Oct.

Abstract

Background: The Brief Intervention for Weight Loss Trial enrolled 1882 consecutively attending primary care patients who were obese and participants were randomised to physicians opportunistically endorsing, offering, and facilitating a referral to a weight loss programme (support) or recommending weight loss (advice). After one year, the support group lost 1.4 kg more (95%CI 0.9 to 2.0): 2.4 kg versus 1.0 kg. We use a cohort simulation to predict effects on disease incidence, quality of life, and healthcare costs over 20 years.

Methods: Randomly sampling from the trial population, we created a virtual cohort of 20 million adults and assigned baseline morbidity. We applied the weight loss observed in the trial and assumed weight regain over four years. Using epidemiological data, we assigned the incidence of 12 weight-related diseases depending on baseline disease status, age, gender, body mass index. From a healthcare perspective, we calculated the quality adjusted life years (QALYs) accruing and calculated the incremental difference between trial arms in costs expended in delivering the intervention and healthcare costs accruing. We discounted future costs and benefits at 1.5% over 20 years.

Results: Compared with advice, the support intervention reduced the cumulative incidence of weight-related disease by 722/100,000 people, 0.33% of all weight-related disease. The incremental cost of support over advice was £2.01million/100,000. However, the support intervention reduced health service costs by £5.86 million/100,000 leading to a net saving of £3.85 million/100,000. The support intervention produced 992 QALYs/100,000 people relative to advice.

Conclusions: A brief intervention in which physicians opportunistically endorse, offer, and facilitate a referral to a behavioural weight management service to patients with a BMI of at least 30 kg/m2 reduces healthcare costs and improves health more than advising weight loss.

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Conflict of interest statement

Competing interests

The trial was funded by the National Prevention Research Initiative of the UK, administered by the MRC. The funding partners are Alzheimer’s Research UK, Alzheimer’s Society, Biotechnology and Biological Sciences Research Council, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Scottish Government Health Directorate, Department of Health, Diabetes UK, Economic and Social Research Council, Engineering and Physical Sciences Research Council, Health and Social Care Research Division, Public Health Agency, Northern Ireland, Medical Research Council, Stroke Association, Wellcome Trust, Welsh Government, and World Cancer Research Fund.

The weight loss programmes we used were provided by Slimming World and Rosemary Conley Health and Fitness Clubs. These are widely available through the English NHS at no cost to the patient and for which these organisations receive a fee. In this trial these 12-week programs were donated to the NHS by both these organisations and we are very grateful to them for this. Neither organisation had input into the protocol, the data analysis, or were involved in the decision to publish the findings. The investigators have no financial relationships with these companies.

Kate Jolly is part-funded by the National Institute for Health Research (NIHR) and Collaboration for Leadership in Applied Health Research and Care (CLAHRC). Paul Aveyard and Susan Jebb are NIHR senior investigators and funded by the Oxford NIHR Biomedical Research Centre and CLAHRC. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health.

Susan Jebb and Paul Aveyard are investigators on an investigator-initiated randomised trial of Cambridge Weight Plan and funded by a research grant to the University of Oxford. None of the investigators have received personal financial payments from any of these research relationships.

Figures

Figure 1
Figure 1. The two scenarios for modelling the effectiveness of interventions
Figure 2
Figure 2. Total cumulative incidence of diseases (cases/100,000 (95%CI)) avoided by year
Figure 3
Figure 3. Cumulative Incidence avoided (cases per 100,000 population) for active relative to support scenarios in the UK by 2035
Figure 4
Figure 4. The ICER (£/QALY) for support versus advice over 20 years
See this image and copyright information in PMC

References

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