Cost‐Effectiveness of a Weight Loss Intervention: An Adaptation of the Look AHEAD Lifestyle Intervention in the US Military

Abstract

Objective This study aimed to assess whether a counselor‐initiated (CI) adaptation of the Look AHEAD (Action for Health in Diabetes) intensive lifestyle intervention in a military setting was cost‐effective relative to a self‐paced (SP) adaptation. Methods A cost‐effectiveness analysis from a payer perspective was performed alongside a 2014‐2017 randomized behavioral weight loss trial among 248 active‐duty military personnel stationed at a US Air Force base in Texas. Incremental cost‐effectiveness ratios were calculated for weight loss, reductions in waist circumference, and quality‐adjusted life‐years (QALYs). Results After 12 months, the CI adaptation cost more per participant compared with the SP adaptation ($1,081 vs. $120) but achieved greater weight loss (1.86 kg vs. 0.06 kg), greater reductions in waist circumference (1.85 cm vs. 0.48 cm), and more QALYs (0.871 vs. 0.856). The incremental cost‐effectiveness ratio for the CI adaptation relative to the SP adaptation was $61,268 per additional QALY. At willingness‐to‐pay thresholds of $50,000 and $100,000 per QALY, the CI adaptation was 45% and 49% likely to be cost‐effective, respectively. Conclusions The CI delivery of the Look AHEAD Intensive Lifestyle Intervention may offer a cost‐effective approach to tackle excess weight in the US military.

Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis

“…Regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions, even cost-effective interventions such as this one [ 24 ]. In order to improve dissemination of behavioral weight management programs to all who are eligible and interested, particularly in settings (eg, primary care) without individuals who may have the time, training, and supervising experience to provide self-monitoring feedback, it may be beneficial to develop strategies for decreasing the amount of time required for crafting each message.…”

“…Given limited research on computer-generated feedback [ 12 , 31 , 32 ] and the common use of counselor-generated feedback [ 9 - 12 ], it is clearly still important to understand in detail the time costs associated with counselor feedback. These details can inform future program budgets, especially since counselor compensation is one of the largest costs [ 21 , 24 , 25 ]. However, since computer-tailored feedback might be more regularly incorporated into future interventions, a better understanding of the efficiency of counselors in crafting feedback may be beneficial to compare these different modalities.…”

“…In studies that have evaluated the cost-effectiveness of behavioral weight loss interventions [ 14 - 25 ], interventionist compensation emerges in the available studies as one of the costliest components [ 21 , 24 , 25 ], including time for conducting the sessions and for providing feedback (ie, review of self-monitoring data, composing feedback). Interventionist costs, however, are often bundled in these analyses [ 21 , 24 , 25 ]; that is, combining time required for the sessions together with time required for providing feedback as well as other intervention tasks. The amount of time for sessions is often quite rigid (eg, 60-90 minutes for group sessions; 20-30 minutes for individual sessions), with standard outlines of material to cover, but little is known about the time associated with providing self-monitoring feedback.…”

“…One study examined costs of providing email feedback for online self-monitoring data, based on retrospective self-reported estimates of counselor time in a “typical week” and “after substantial implementation experience,” but bundled all intervention costs together (ie, session preparation, conducting the group session, review of self-monitoring journals, periodic contact of participants who might miss sessions or who have questions, posting on the bulletin board, record keeping, technical work by the webmaster) [ 21 , 24 ]. To our knowledge, only one behavioral intervention specifically reported isolated counselor feedback time, using an average weekly estimate for the entire intervention, but it is not clear whether this information was collected contemporaneously or retrospectively [ 26 ].…”

Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis (Preprint)

“…In studies that have evaluated the cost-effectiveness of behavioral weight loss interventions [14][15][16][17][18][19][20][21][22][23][24][25], interventionist compensation emerges in the available studies as one of the costliest components [21,24,25], including time for conducting the sessions and for providing feedback (ie, review of self-monitoring data, composing feedback). Interventionist costs, however, are often bundled in these analyses [21,24,25]; that is, combining time required for the sessions together with time required for providing feedback as well as other intervention tasks. The amount of time for sessions is often quite rigid (eg, 60-90 minutes for group sessions; 20-30 minutes for individual sessions), with standard outlines of material to cover, but little is known about the time associated with providing self-monitoring feedback.…”