A within-trial cost-effectiveness analysis of primary care referral to a commercial provider for weight loss treatment, relative to standard care--an international randomised controlled trial.

BACKGROUND: Due to the high prevalence of overweight and obesity there is a need to identify cost-effective approaches for weight loss in primary care and community settings. OBJECTIVE: We evaluated the cost effectiveness of two weight loss programmes of 1-year duration, either standard care (SC) as defined by national guidelines, or a commercial provider (Weight Watchers) (CP). DESIGN: This analysis was based on a randomised controlled trial of 772 adults (87% female; age 47.4±12.9 years; body mass index 31.4±2.6 kg m(-2)) recruited by health professionals in primary care in Australia, United Kingdom and Germany. Both a health sector and societal perspective were adopted to calculate the cost per kilogram of weight loss and the ICER, expressed as the cost per quality adjusted life year (QALY). RESULTS: The cost per kilogram of weight loss was USD122, 90 and 180 for the CP in Australia, the United Kingdom and Germany, respectively. For SC the cost was USD138, 151 and 133, respectively. From a health-sector perspective, the ICER for the CP relative to SC was USD18 266, 12 100 and 40 933 for Australia, the United Kingdom and Germany, respectively. Corresponding societal ICER figures were USD31,663, 24,996 and 51,571. CONCLUSION: The CP was a cost-effective approach from a health funder and societal perspective. Despite participants in the CP group attending two to three times more meetings than the SC group, the CP was still cost effective even including these added patient travel costs. This study indicates that it is cost effective for general practitioners (GPs) to refer overweight and obese patients to a CP, which may be better value than expending public funds on GP visits to manage this problem.

[Juvenile obesity and comorbidity type 2 diabetes mellitus (T2 DM) in Germany: development and cost-of-illness analysis]. / Adipositas und die Komorbidität Diabetes mellitus Typ 2 bei Kindern und Jugendlichen in Deutschland: Entwicklung und Krankheitskostenanalyse.

PURPOSE: Obesity and type 2 diabetes mellitus (T2 DM) among children have increased in the last years and developed into a major public health problem in Germany. Obesity and T2 DM are important causes of morbidity among young people associated with high costs for the health system. The objective of this paper is to estimate the number of obese and diabetic children and adolescents and the associated economic burden of illness in Germany now (2003) and in the future. METHODS: Cost assessments of obesity in adulthood and studies of obese children in Germany are based on English and German scientific publications and internet sources. Cost calculations are based on the top-down approach and the prevalence method. Direct costs of illness are derived from aggregate statistical data (ICD 10: obesity E 65-68; T2 DM E 11) and various scientific publications and telephone interviews. Except for T2 DM, other comorbidities of obesity are neglected in this analysis. RESULTS: In 1999, 1.3 million children were overweight and 594,000 were obese in Germany. The highest prevalence of obesity was in children aged 14 to 17 years. The prevalence for overweight children has risen from 8.9 % to 15.7 % and for obese children from 10.1 % to 13.1 % over the period from 1994 to 1999/1998. Approximately 1 % of these were type 2 diabetics. During 2003, the mean annual direct costs of obesity were euro 44 million, with euro 36.4 million for rehabilitation, euro 3.6 million for hospital care and euro 3.9 million for special medical programs. The costs of juvenile T2 DM were euro 1.4 million (hospital care and rehabilitation). Mean costs per treated obese child added up to euro 3484.00 and to euro 8539.00 per treated obese child with T2 DM. The incremental costs are euro 2489.00 for obese children and euro 7544.00 for obese children with T2 DM compared to the average costs of illness of a child aged 5 to 20 years in Germany. Future annual attributable costs of obesity could be up to euro 6.4 million, 7.3-10.1 % of all obesity costs and for T2 DM up to euro 17.3 million (without T2 DM comorbidities) and euro 92.1 million (inclusive of all T2 DM comorbidities), 7.0-55.6 % of all obesity costs. CONCLUSIONS: Obesity and T2 DM are rapidly emerging as major disorders of childhood and adolescence and as important cost drivers for the health system. Due to the lack of data, there is a need for further research in the costs of obesity and T2 DM among children and for studies on suitable interventions to obviate a major public health crisis in Germany. The challenge for health policy is to identify effective and efficient prevention strategies.

Future direct and indirect costs of obesity and the influence of gaining weight: results from the MONICA/KORA cohort studies, 1995-2005.

Over the last two decades, the prevalence of obesity has risen worldwide. As obesity is a confirmed risk factor for a number of diseases, its increasing prevalence nurtures the supposition that obesity may present a growing and significant economic burden to society. The objective of this study is to analyse the correlation between body mass index (BMI) and future direct and indirect costs, as well as the correlation between changing BMI and future in(direct) costs. Health care utilisation and productivity losses were based on data from 2581 participants aged 25-65 years (1994/95) from two cross-sectional, population-representative health surveys (MONICA/KORA-survey-S3 1994/95 and follow-up KORA-survey-F3 2004/05) in Augsburg, Germany. The predicted average adjusted total direct costs per year and per user were estimated to be €1029-(healthy weight), €1093-(overweight) and €1040-(obesity). There are significantly greater future costs in the utilisation of general practitioners per user and per year at higher obesity levels (€72; €75; €96). The average total direct costs per person for those who stay in the same BMI class are €982, €1000 and €973. An overweight participant who becomes obese incurs significant costs of internists of €160 compared with those who remain overweight (€124). An overweight user incurs indirect costs of €2474, compared with €2136 for those who remain a healthy weight. There is a trend for higher predicted (in)direct costs when people are overweight or obese compared with healthy weight persons 10 years earlier. Potential cost savings could be attained if preventive programs effectively targeted these individuals.