Is Doctor Referral to a Low-Energy Total Diet Replacement Program Cost-Effective for the Routine Treatment of Obesity?

Abstract

Objective: The study objective was to estimate the cost-effectiveness of a commercially provided low-energy total diet replacement (TDR) program compared with nurse-led behavioral support. Methods: A multistate life table model and the weight reduction observed in a randomized controlled trial were used to evaluate the quality-adjusted life-years and direct health care costs (in United Kingdom 2017 prices) over a lifetime with TDR versus nurse-led support in adults who had obesity, assuming that (i) weight returns to baseline over 5 years and (ii) a 1-kg weight loss is maintained after 5 years following TDR. Results: The per-person costs of the TDR and nurse-led programs were £796 and £34, respectively. The incremental cost-effectiveness ratio of TDR was £12,955 (95% CI: £8,082-£17,827) assuming that all weight lost is regained and £3,203 (£2,580-£3,825) assuming that a 1-kg weight loss is maintained after 5 years. TDR was estimated to be more cost-effective (i.e., lower incremental cost-effectiveness ratios) in older adults and those with a higher BMI, with little difference by gender. Conclusions: At current retail prices and with plausible long-term weight regain trajectories, TDR is projected to be cost-effective in adults with obesity and could be considered as an option to treat obesity in routine health care settings.