BOSTON – Intensive behavioral counseling as recommended by the U.S. Preventive Services Task Force for obese and overweight adults at risk for cardiovascular disease would increase quality-adjusted life years in a cost-effective manner in the U.S. population, according to a lifetime disease progression model.
For each person receiving the intervention, the model showed an average increase in quality-adjusted life years (QALY) of 0.019 at a cost of $197 over 25 years. The incremental cost-effectiveness ratio was $10,500 per QALY, Ping Zhang, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, reported at the annual scientific sessions of the American Diabetes Association.
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“Given a conventional willingness to pay at $50,000 per QALY, we would say it’s pretty cost-effective,” Dr. Zhang said, noting that in this model representing 101 million U.S. adults, 23,000 cases of cardiovascular disease and 671,000 cases of diabetes would be prevented at a total intervention cost of $58 billion.
Given that “huge amount,” he and his colleagues stratified individuals based on body mass index and cardiovascular disease risk factors to determine who would benefit most from intervention. They found the intervention to be cost saving or above cost saving in obese individuals with impaired fasting glucose (with the greatest benefits in those with at least two additional risk factors), and to be cost-effective or above cost-effective in obese individuals without impaired fasting glucose and in overweight individuals with impaired fasting glucose, he said.
For those who are overweight but who do not have impaired fasting glucose, the cost of intervention was above $50,000 and thus not considered cost-effective.
The USPSTF recommendations, made in August 2014 based on health benefits of such counseling as demonstrated in randomized clinical trials, call for intensive behavioral counseling interventions to promote a healthful diet and physical activity in overweight and obese adults with at least one cardiovascular disease risk factor, such as hypertension, dyslipidemia, impaired fasting glucose, or metabolic syndrome.
To examine the long-term health implications and cost-effectiveness of the recommendations, Dr. Zhang and his colleagues estimated baseline risk factor levels and population characteristics based on 2005-2012 National Health and Nutrition Examination Survey (NHANES) data, and based assumptions about the effectiveness of the interventions on USPSTF data showing a 54% reduction in risk of diabetes, a 2.06 mm Hg reduction in systolic blood pressure, a 5.43 mg/dL reduction in total cholesterol, and 1.0 kg/m2 reduction in body mass index after a median of 16 sessions in 12 months.
Costs of counseling were assumed to be $576 per person based on reported estimates, and future QALYs and costs were discounted at 3% per year.
Dr. Zhang recommended prioritizing interventions. If resources are limited, invest first in those with the highest risk: obese adults with impaired fasting glucose and hypertension, followed by those who are obese and have impaired fasting glucose, he advised.
Dr. Zhang reported having no disclosures.