Cost-effectiveness study

M - Click here for explanation of classification scheme.

POSITIVE: See Quality Criteria Checklist below.

• To determine if a nutrition research protocol could be translated into clinical practice and meet the demand of increased referral to the service
• To evaluate the effectiveness and resource implication of intensive nutrition intervention
• To evaluate the effectiveness of providing alternative methods of dietetic review as an option for patients unable to participate in an intensive program.

• Referred to a dietitian for weight reduction from the Gastroenterology and Hepatitis management clinics at the Princess Alexandra hospital between February 2003 and March 2005
• BMI of at least 25kg/m².

• Patients unable to participate in the intensive program were offered standard dietetic therapy for weight reduction
• Patients who declined dietetic therapy entirely were offered written material summarizing the food and exercise education provided throughout the program.

Recruitment

 All subjects were patients in the clinic who were referred for weight reduction.

Design

  This was a cost-effectiveness study of treatment provided by one dietitian in a specific clinic during the study period. 

• Intensive therapy consisted of weekly review for 12 weeks followed by weight maintenance program of monthly review for 12 months. Group education was introduced during the initial six weeks, with patients reviewed weekly for one hour to 1.5 hours in groups of six to eight patients using cognitive behavior therapy. During the second six weeks, patients were reviewed individually for 15 minutes to 20 minutes, with the goal to lose weight no faster than 0.5kg per week. The 12-month maintenance program involved support to prevent relapse.
• Standard care provided to patients not able to participate in intensive treatment included an initial one-hour consultation with the dietitian, including individualized dietary and physical activity recommendations, and follow-up of 15-minute to 30-minute appointments when scheduled by the patient.

Intervention

A more intensive treatment plan was implemented and studied for effectiveness.

Statistical Analysis

SPSS for Windows version 11.0, statistical significance P<0.05.

 

Timing of Measurements

Measurements were recorded at each visit, which varies with treatment group over the course of the six-month study period.

Dependent Variables

• Weight (kg)
• Waist circumference (cm)
• Height (cm)
• Patient retention (completion of program)
• Patient attendance (number of appointments)
• Alanine aminotransferase (ALT, U/L)
• Cost (Australian dollars).

Independent Variables

• Sex
• Age
• Work status.

Control Variables

Level of therapy.

• Initial N: N=93
• Attrition (final N): N=65 (30% attrition); intensive program 48 (50% male); standard therapy 17 (47% male)
• Age: Intensive 51.1±1.8 years; standard 45.2±2.3 years
• Other relevant demographics: Work status not statistically different between groups
• Anthropometrics: Waist circumference was significantly higher in the intensive treatment group (113±1.7cm vs. 105±2.4cm, P=0.04)
• Location: Queensland, Australia.

Key Findings

• 83% of patients in intensive treatment program achieved weight loss at six months. Only 24% of patients in standard treatment program achieved weight loss.
• Intensive treatment patients significantly decreased waist circumference to 108±2cm (P<0.001).
• Results of dietetic service provision for intensive intervention group at six months: Intensive intervention costs include 12 weeks of intensive intervention (six weeks of group sessions and six weeks of individual review) and monthly follow-up of three months. Costs extrapolated from total costs incurred divided by total weight balance (losses + gains) of all patients continuing in follow up at six months.

Parameter	Result
Mean weight loss (total group)	4.3kg
Number of patients achieving weight loss	26 (83%)
Cost per patient ($AU)	$87.50
Cost per kg lost ($AU)	$31.00

 

Other Findings

Patients who decreased weight circumference experienced significant improvement in ALT (P<0.001).

An intensive structured dietetic program provided as part of standard clinical practice can be an effective method of weight reduction for overweight patients with liver disease and is a feasible treatment option for weight management in a clinical outpatient setting. The cost of providing an intensive weight loss intervention compares favorably to other weight loss methods involving pharmacotherapy. An outpatient-based, intensive lifestyle intervention is a feasible treatment option for weight management in overweight patients with chronic liver disease.

University/Hospital:

Princess Alexandra Hospital