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Cost-utility analysis of a randomized controlled weight loss trial among lactating overweight/obese women

Journal article
Authors Lars A Hagberg
Hilde Kristin Brekke
Fredrik Bertz
Anna Winkvist
Published in BMC Public Health
Volume 15
Issue 1
ISSN 1471-2458
Publication year 2014
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Language en
Subject categories Clinical Medicine


Abstract Background Overweight and obesity among young, adult women are increasing problems in Sweden as in many other countries. The postpartum period may be a good opportunity to improve eating habits and lose weight in a sustainable manner. The aim was to make a cost-utility analysis of a dietary behavior modification treatment alongside usual care, compared to usual care alone, among lactating overweight and obese women. Methods This study was a cost-utility analysis based on a randomized controlled and longitudinal clinical diet intervention. Between 2007-2010, 68 women living in Sweden were, after baseline measurement at 8-12 weeks postpartum, randomly assigned to a 12-week dietary behavior modification treatment or control group. Inclusion criteria were: self-reported pre-pregnancy body mass index (BMI) 25-35 kg/m2, non-smoker, singleton term delivery, birth weight > 2500 g, intention to breastfeed for 6 mo and no diseases (mother and child). The women in the intervention group received 1.5 hour of individual counseling at study start and 1 hour at follow-up home visits after 6 weeks of intervention, with support through cell phone text messages every two wk. Dietary intervention aimed to reduce dietary intake by 500 kcal/day. The control group received usual care. Weight results have previously been reported. Here we report on analyses carried out during 2012-2013 of cost per quality adjusted life years (QALY), based on the changes in quality of life measured by EQ-5D-3 L and SF-6D. Likelihood of cost-effectiveness was calculated using Net Monetary Benefit method. Results Based on conservative assumptions of no remaining effect after 1 year follow-up, the diet intervention was cost-effective. Costs per gained QALY were 8 643 – 9 758 USD. The likelihood for cost-effectiveness, considering a willingness to pay 50 000 USD for a QALY, was 87–93%. Conclusions The diet intervention is cost-effective. Trial registration Identifier: NCT01343238 Registered April 27, 2011. The regional ethics committee in Gothenburg, Sweden, approved the study on November 15, 2006.

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