Elsevier

Public Health

Volume 128, Issue 9, September 2014, Pages 804-810
Public Health

Original Research
The cost-effectiveness of weight management programmes in a postnatal population

https://doi.org/10.1016/j.puhe.2014.07.005Get rights and content

Highlights

  • The cost-effectiveness of weight management programmes was estimated.

  • A model based on a regression equation predicting change in weight was developed.

  • The model estimated the cost effectiveness of a weight management programme.

  • The model was measured in terms of an incremental cost-effectiveness ratio (ICER).

  • The results show the programme was cost-effective at a threshold of £20,000 per QALY.

Abstract

Objectives

The aim of the study was to estimate the cost-effectiveness of a weight management programme including elements of physical exercise and dietary restriction which are designed to help women lose excess weight gained during pregnancy in the vulnerable postnatal period and inhibit the development of behaviours which could lead to future excess weight gain and obesity.

Study design

A mathematical model based on a regression equation predicting change in weight over a fifteen year postnatal period was developed.

Methods

The model included programme effectiveness and resource data based on a randomized controlled trial of a weight management programme implemented in a postnatal population in the United States. Utility and mortality data based on body mass index categories were also included. The model adopted a National Health Service (NHS) and personal social services (PSS) perspective, a lifetime time horizon and estimated the cost effectiveness of a weight management programme against a no change comparator in terms of an incremental cost-effectiveness ratio (ICER).

Results

The baseline results show that the difference in weight between women who received the weight management programme and women who received the control intervention was 3.02 kg at six months and 3.53 kg at fifteen years following childbirth. This results in an ICER of £7355 per quality adjusted life year (QALY) for women who were married at childbirth.

Conclusion

The estimated ICER would suggest that such a weight management programme is cost-effective at a NICE threshold of £20,000 per QALY. However significant structural and evidence based uncertainty is present in the analysis.

Introduction

The proportion of the population in England and Wales who are overweight or obese is increasing.1, 2 This has led to an increase in the prevalence of weight related diseases which in turn are associated with an increase in morbidity, mortality and the costs incurred by health services in treating and managing them. During pregnancy an increase in weight is recommended so that women can remain healthy and satisfy the increased energy demands of gestation. The American Institute of Medicine has issued guidelines for the recommended gestational weight gain based on prepregnancy body mass index (BMI) and are detailed in Table 1.3

However the period following childbirth is one of the most vulnerable for the development of lifestyles that may lead to excessive weight gain.4 The most effective time for women to lose excess weight gained during pregnancy is the six month postnatal period.5

A mathematical model was constructed on behalf of the National Institute for Health and Care Excellence (NICE) to estimate the cost-effectiveness associated with the implementation of a hypothetical public health programme designed to encourage women to lose the excess weight gained during pregnancy in the six month postnatal period.6 The results of the modelling process were used to inform the development of UK public health guidance issued by NICE.7

Section snippets

Methods

A systematic literature search of electronic databases for papers published between 1990 and 2009 relating to weight management interventions which encourage women to return to their prepregnancy weight in the six month postnatal period through physical exercise, dietary management or both was conducted in August 2009 and returned 4414 references. The titles, abstracts and finally the full papers of these identified references were assessed against inclusion and exclusion criteria until five

Results

The deterministic and stochastic (PSA) results are presented in Table 5. Both sets of results indicate that at a threshold of £20,000 per QALY the weight management programme is cost-effective. A jack knife methodology as described in Ref. 22 was used to calculate the mean and the associated 95% confidence intervals around each stochastic result.

Discussion

This work evaluated the costs incurred and QALYs accrued from the implementation of a weight management programme combining a supervised aerobic exercise programme and a healthy calorie controlled diet to a postnatal population in the United Kingdom. This is the first modelling study to examine the potential economic impact of such an intervention and this work has been presented as a foundation for future research.

The ICER of £7355 (£6766–£7945) is significantly below the willingness to pay

Author statements

The views expressed in this manuscript are those of the authors and do not necessarily reflect those of the Centre for Public Health Excellence as part of the National Institute for Health and Care Excellence in the United Kingdom.

References (25)

  • E.A. Leermakers et al.

    Reducing postpartum weight retention through a correspondence intervention

    Int J Obes

    (1998)
  • M.L. O'Toole et al.

    Structured diet and physical activity prevent postpartum weight retention

    J Womens Health

    (2003)
  • Cited by (4)

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