Five-Year Medical and Pharmacy Costs After a Medically Supervised Intensive Treatment Program for Obesity
ABSTRACT Abstract Purpose . The financial impact of intensive medical interventions for weight loss has not been fully studied. Design . A randomized pragmatic clinical trial. Setting . Seven primary care clinics and one research center in Louisiana. Subjects . Severely obese individuals (body mass index 40-60 kg/m(2)) randomized to usual care (n = 190) or intensive medical management (n = 200). Forty-seven percent of participants completed year 2 follow-up and were included in the analyses. Intervention . Physician-monitored intervention with recommendations for 12 weeks of liquid diet followed by 4 months of group behavioral therapy, structured diet, and option of pharmacotherapy, and an additional 16 months of maintenance strategies. Measures . Two-year preintervention and 5-year postintervention measures were computed from claims data and included (1) medical costs excluding pharmacy, (2) pharmacy costs only, (3) total medical and pharmacy costs, and (4) medical and pharmacy subcategory costs. Analysis . Differential categories for preintervention and postintervention were created using total sample 75th percentiles. Chi-square tests were employed to compare the intervention groups both preintervention and postintervention with respect to the proportion of subjects above the 75th percentile for each of the cost categories. Results . Medical costs excluding pharmacy did not differ between groups. The intensive medical intervention group had a significantly smaller percentage of subjects above the 75th percentile for pharmacy costs only (p = .0125), and for antidiabetic agents (p = .0464), antihypertensives (p = .0075), and dyslipidemic subcategories (p = .0197). Conclusion . An intensive medical intervention may reduce pharmaceutical expenditures in severely obese individuals. These results must be viewed with caution given the high attrition of study participants.
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ABSTRACT: To examine the effect of a lifestyle intervention to produce weight loss and increased physical fitness on use and cost of medications to treat cardiovascular disease (CVD) risk factors in people with type 2 diabetes. Look AHEAD is a multicenter randomized controlled trial of 5,145 overweight or obese individuals with type 2 diabetes, aged 45-76 years. An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition. Medications prescribed to treat diabetes, hypertension, and hyperlipidemia were compared at baseline and 1 year. Medication costs were conservatively estimated using prices from a national online pharmacy. Participants randomized to an ILI had significantly greater improvements in CVD risk parameters and reduced medication use and cost compared with those assigned to DSE. At 1 year, average number of medications prescribed to treat CVD risk factors was 3.1 +/- 1.8 for the ILI group and 3.6 +/- 1.8 for the DSE group (P < 0.0001), with estimated total monthly medication costs of $143 and $173, respectively (P < 0.0001). DSE participants meeting optimal care goals at 1 year were taking an average of 3.8 +/- 1.6 medications at an estimated cost of $194/month. ILI participants at optimal care required fewer medications (3.2 +/- 1.7) at lower cost ($154/month) (P < 0.001). At 1 year, ILI significantly improved CVD risk factors, while at the same time reduced medication use and cost. Continued intervention and follow-up will determine whether these changes are maintained and reduce cardiovascular risk.Diabetes care 03/2010; 33(6):1153-8. DOI:10.2337/dc09-2090
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ABSTRACT: Excessively obese adults often acquire many metabolic disorders that put them at high risk for developing type 2 diabetes mellitus and cardiovascular disease. We investigated the hypothesis that cardiometabolic risk in a primary care cohort of 208 excessively obese adults (body mass index 40-60 kg/m(2), 48 with type 2 diabetes mellitus) would deteriorate with additional weight gain and improve incrementally beginning with 5% weight reduction. Further analysis of the Louisiana Obese Subjects Study of excessively obese patients enrolled and followed during 2005-2008 is reported. Weight loss correlated significantly with improvements in fasting plasma glucose, triglycerides, high- and low-density lipoprotein cholesterol, uric acid, alanine aminotransferase, lactate dehydrogenase, and high-sensitivity C-reactive protein. Most parameters deteriorated with weight gain and progressively improved with 5% or more weight loss. Except for low-density lipoprotein cholesterol, all risk factors significantly improved with ≥ 20% loss of body weight. Among patients who had not been diagnosed with type 2 diabetes mellitus and had normoglycemia at baseline, median fasting plasma glucose increased significantly (13%) with stable or gained weight at 1 year, but did not change significantly with reduced weight. Although glucose levels did not change significantly in patients with type 2 diabetes mellitus who gained weight, a decline beginning after 5% weight reduction culminated in 25% glucose reduction with ≥ 20% weight loss. Resting blood pressure declined independently of weight change. Very obese adults can improve their cardiometabolic risk under primary care weight management. Incremental success may help motivate further therapeutic weight reduction.The American journal of medicine 10/2011; 124(10):931-8. DOI:10.1016/j.amjmed.2011.04.033
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ABSTRACT: The cost of diabetes mellitus can be defined in both medical and economic terms. Although there is an abundance of literature concerning the medical management of diabetes, few studies have assessed the financial impact of its treatment. This study examined the savings in prescription costs associated with a weight reduction program for obese men and women with non-insulin-dependent diabetes mellitus (NIDDM). Forty subjects ages 40-70 years who had body mass indexes of 30-40 kg/m2 and NIDDM of more than 1 year duration were assigned to one of two 800-kcal weight-loss programs for 12 weeks. A cost analysis was done on the 32 subjects who were taking anti-hypertensive and/or anti-diabetes medications. A list of medications and monthly amounts was obtained at the start, upon completion, and 1 year following completion of the diet. The average out-of-pocket cost for a month's supply of each prescription was calculated by polling 16 retail pharmacies in Lexington, Kentucky. Subjects lost an average of 15.3 kg (33.7 lb) over the 12 weeks. At 1-year follow-up, subjects maintained a mean 9.0-kg (19.8 lb) weight loss. The average monthly prediet out-of-pocket cost for anti-hypertensive and anti-diabetes medications and supplies was $63.30 per subject. Following completion of the diet, this cost per month decreased to $20.40 and at 1-year follow-up the average monthly cost per subject was $32.40. The estimated average savings in prescription costs per subject over the year was $442.80. Significant short- and long-term savings in prescription costs were obtained following a 12-week hypocaloric weight reduction program for obese individuals with NIDDM.Preventive Medicine 08/1995; 24(4):369-74. DOI:10.1006/pmed.1995.1060