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The waiting game

GP-led weight management programme is 'highly cost-effective'

By Lilian Anekwe

A primary care weight management programme can help obese patients reduce their weight and is highly cost effective, according to an analysis by leading UK obesity researchers.

A study of the costs and outcomes of the Counterweight programme to manage the weight of patients with type 2 diabetes, coronary heart disease and colon cancer found the programme cost £60 per patient to deliver but would save far more.

The evaluation was based on a 12-month programme run in 65 practices with 1,419 patients with a BMI of 25 kg/m2 or over who were counselled by ‘weight management advisers' – usually practice nurses or other primary health care workers.

Counterweight cost £59.83 per patient entered. Patients enrolled in the counterweight programme lost a mean of 3kg after 12 months and 2.3kg after 24 months, both of which were 4kg below the predicted 1kg/year background weight gain.

The health economics model the researchers used to calculate the programme's cost-effectiveness assumed 55% of patients would either drop out or not attend after 12 months.

In a ‘worst-case scenario' where the 12-month achieved weight loss was entirely regained over the next 2 years, the quality-adjusted life-year (QALY) cost of the programme was £2,017 where weight gain was 0.5 kg ? year, and £2,651 at 0.3 kg ? year.

The researchers, who included Dr David Haslam, clinical director of the National Obesity Forum and health economists from the University of York's centre for health economics, called for weight management programmes to be routinely adopted in primary care.

‘Weight management for obesity in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare resources use could offset the total cost of providing the Counterweight programme, as well as bringing multiple health and quality of life benefits,' they concluded.

Professor Mike Lean, professor of human nutrition at the University of Glasgow, said: ‘Based on very conservative estimates of effect, using the NICE health economics formula and assuming weight gain resumes after a two-year intervention, the evidence-based Counterweight programme is shown to be not just cost-effective but cost-saving.

‘The savings which result over life from predicted delays in secondary health problems exceed the costs of providing the programme within routine primary care.'

Dr Paul Singer, a GP in Luton whose practice took part in the Counterweight programme, said: ‘Overall it was success in terms of measureable outcomes. We did achieve a small but sustained weight loss, but it was very labour intensive. The nurses had to spend a lot of time with each patient and so it may not have been cost-effective for that reason. But we are still using some of the Counterweight tools now, but have had to modify them to save nursing time.'

Int J Clin Pract 2010,64,6,775-783

GP-led weight management programme is 'highly cost-effective'

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