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Hoch JS, Kohatsu ND, Fleuret J, Backman DR. Cost-Effectiveness Analysis of a Community-Based Telewellness Weight Loss Program. AJPM FOCUS 2024; 3:100182. [PMID: 38304023 PMCID: PMC10832372 DOI: 10.1016/j.focus.2024.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Introduction The purpose of this study was to perform a cost-effectiveness analysis of the Koa Family Program, a community-based telewellness weight reduction intervention for overweight and obese women aged 21-45 years with low income. The Koa Family Program resulted in an approximately 8-pound weight loss as demonstrated in an RCT published previously. Methods Estimates for the cost-effectiveness were derived from the prospective 25-week RCT including 70 women (25 kg/m2≤BMI<40 kg/m2). The analysis was from a program-funder perspective. Base case costs, as well as low and high scenario costs, were estimated from the services provided to intervention participants. The incremental costs were compared with the incremental effectiveness, with weight loss being the outcome of interest. Costs were in 2021 U.S. dollars. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio and the incremental net benefit. The statistical uncertainty was characterized using an incremental net benefit by willingness-to-pay plot and a cost-effectiveness acceptability curve. Results The base case average cost per participant was $564.39. The low and high scenario average costs per participant were $407.34 and $726.22, respectively. Over the 25-week study timeframe, participants lost an average 7.7 pounds, yielding a base case incremental cost-effectiveness ratio of approximately $73 per extra pound lost. The probability that the Koa Family Program is cost-effective is 90%, assuming a willingness-to-pay of $115 for a 1-pound reduction, and is 95%, assuming a willingness-to-pay of $140. Conclusions The Koa Family Program provides good value with cost-effectiveness in line with other weight-loss interventions. This is a striking finding given that the Koa Family Program serves a more vulnerable population than is typically engaged in weight loss research studies.
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Affiliation(s)
- Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Neal D. Kohatsu
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Julia Fleuret
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Desiree R. Backman
- Center for Healthcare Policy and Research, University of California, Davis, California
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Lockard B, Mardock M, Oliver JM, Byrd M, Simbo S, Jagim AR, Kresta J, Baetge CC, Jung YP, Koozehchian MS, Khanna D, Rasmussen C, Kreider RB. Comparison of Two Diet and Exercise Approaches on Weight Loss and Health Outcomes in Obese Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4877. [PMID: 35457744 PMCID: PMC9032860 DOI: 10.3390/ijerph19084877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
AIM To compare the efficacy of two popular weight loss approaches on weight loss, body composition, and markers of health in sedentary obese women. METHODS In total, 51 sedentary women (age 34.5 ± 7.7 yrs.; weight 90.0 ± 14.5 kg; BMI 34.0 ± 5.1 kg/m2; 46.5 ± 7.0% fat) were matched and randomized to participate in the Weight Watchers® Momentum™ (WW) or Curves® (CV) Fitness and Weight Management program for 16 weeks. Participants in the WW group (n = 27) were provided a point-based diet program, received weekly progress checks and counseling, and were encouraged to exercise. Participants in the CV group (n = 24) followed a menu-based higher protein/low-fat diet (1200 kcal/d) for 1 week; 1500 kcal/d diet for 3 weeks; and 2000-2500 kcals/d for 2 weeks that was repeated three times (except the last segment) while participating in a supervised circuit-style resistance training program (3 d/wk). A general linear model (GLM) with repeated measures was used to analyze data and are presented as mean changes from baseline (mean [UL, LL]). RESULTS Supervised CV training resulted in greater amounts of vigorous and total physical activity. After 16 weeks, both groups lost weight (WW -6.1 [-7.8, -4.6], CV -4.9 [-6.2, -3.2] kg, p = 0.264). Participants in the CV group observed greater reductions in fat mass (WW -2.9 [-6.7, -0.2], CV -6.4 [-9.2, -3.6] kg, p = 0.081) and increases in lean mass (WW -2.5 [-4.3, -0.7], CV 1.3 [-0.6, 3.2] kg, p = 0.005) resulting in more favorable changes in percent body fat (WW -1.4 [-4.1, 1.2], CV -4.7 [-7.5, -1.8]%, p = 0.098). Both groups observed improvements in peak aerobic capacity and muscular endurance, although bench press lifting volume was greater in the CV group. Those in the CV group experienced a greater increase in HDLc and reduction in the CHL-HDLc ratio and triglycerides. CONCLUSION Both interventions promoted weight loss and improvements in fitness and markers of health. The CV program, which included supervised resistance training and higher protein diet menus, promoted greater fat loss, increases in lean mass, and improvements in percent body fat and blood lipids. TRIAL REGISTRATION clinicaltrials.gov, #NCT04372771, registered retrospectively 1 May 2020.
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Affiliation(s)
- Brittanie Lockard
- School of Nursing and Health Professions, University of the Incarnate Word, San Antonio, TX 78209, USA;
| | - Michelle Mardock
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
| | - Jonathan M. Oliver
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
| | - Mike Byrd
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
- Byrd’s Eye Enterprises, Inc., Forney, TX 75126, USA
| | - Sunday Simbo
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
- Center for Translational Research in Aging & Longevity, Human Clinical Research Facility, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Andrew R. Jagim
- Department of Sports Medicine, Mayo Clinic Health System, Onalaska, WI 54650, USA;
| | - Julie Kresta
- College of Education and Human Development, Texas A&M University Central-Texas, Killeen, TX 76549, USA;
| | - Claire C. Baetge
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
| | | | - Majid S. Koozehchian
- Department of Kinesiology, Jacksonville State University, Jacksonville, AL 36265, USA;
| | - Deepesh Khanna
- Department of Foundational Sciences, Nova Southeastern University, Clearwater, FL 33759, USA;
| | - Chris Rasmussen
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
| | - Richard B. Kreider
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health and Kinesiology, Texas A & M University, College Station, TX 77843, USA; (M.M.); (J.M.O.); (M.B.); (S.S.); (C.C.B.); (C.R.)
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O'Neil A, Thompson K, Russell JD, Norton R. Inequalities and Deteriorations in Cardiovascular Health in Premenopausal US Women, 1990-2016. Am J Public Health 2020; 110:1175-1181. [PMID: 32552022 PMCID: PMC7349459 DOI: 10.2105/ajph.2020.305702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 11/04/2022]
Abstract
Coronary heart disease (CHD) mortality rates in the United States have declined by up to two thirds in recent decades. Closer examination of these trends reveals substantial inequities in the distribution of mortality benefits. It is worrying that the uneven distribution of CHD that exists from lowest to highest social class-the social gradient-has become more pronounced in the United States since 1990 and is most pronounced for women.Here we consider ways in which this trend disproportionately affects premenopausal women aged 35 to 54 years. We apply a social determinants of health framework focusing on intersecting axes of inequalities-notably gender, class, ethnicity, geographical location, access to wealth, and class-among other power relations to which young and middle-aged women are especially vulnerable, and we argue that increasing inequalities may be driving these unprecedented deteriorations. We conclude by discussing interventions and policies to target and alleviate inequality axes that have potential to promote greater equity in the distribution of CHD mortality and morbidity gains.The application of this framework in the context of women's cardiovascular health can help shed light regarding why we are seeing persistently poorer outcomes for premenopausal US women.
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Affiliation(s)
- Adrienne O'Neil
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
| | - Kelly Thompson
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
| | - Josephine D Russell
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
| | - Robyn Norton
- Adrienne O'Neil and Josephine D. Russell are with Heart and Mind Research, iMPACT Institute, School of Medicine, Deakin University, Geelong, Victoria, Australia. Adrienne O'Neil is also with Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria. Kelly Thompson and Robyn Norton are with Global Women's Health, The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia. Robyn Norton is also with University of Oxford, Oxford, United Kingdom
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