Comparing Costs of Telephone vs Face-to-Face Extended-Care Programs for the Management of Obesity in Rural Settings

Department of Family Medicine, University of Colorado Denver, Aurora, USA.
Journal of the American Academy of Nutrition and Dietetics (Impact Factor: 3.47). 07/2012; 112(9):1363-73. DOI: 10.1016/j.jand.2012.05.002
Source: PubMed


A major challenge after successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge can be exacerbated in rural areas with limited local support resources.
This study describes and compares program costs and cost effectiveness for 12-month extended-care lifestyle maintenance programs after an initial 6-month weight-loss program.
We conducted a 1-year prospective randomized controlled clinical trial.
The study included 215 female participants age 50 years or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003 to May 31, 2007.
The intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly assigned to a 12-month extended-care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74).
Program delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample.
Nonparametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance.
Median weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared with individual telephone counseling ($268 per participant) and control ($226 per participant) programs. Although the net weight lost after the 12-month maintenance program was higher for the face-to-face and telephone programs compared with the control group, the average cost per expected kilogram of weight lost was higher for the face-to-face program ($47/kg) compared with the other two programs (approximately $33/kg for telephone and control).
Both the scale of operations and local demand for programs are important considerations in selecting a delivery format for lifestyle maintenance. In this study, the telephone format had a lower cost but similar outcomes compared with the face-to-face format.

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Available from: Lesley Lutes, Apr 22, 2014
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    • "Telephone interventions for CVD risk behaviours in the general population have been shown to be cost-effective (Graves et al., 2009; Smith et al., 2011) and at a lower cost than face-toface interventions (Radcliff et al., 2012). A telephone intervention may also overcome attendance barriers. "
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    • "An intervention to promote behavior change and then to promote maintenance of those changes ideally would be intensive during the initiation phase to promote behavior change (LeBlanc, O'Connor, Whitlock, Patnode, & Kapka, 2011), after which intensity could be reduced while still maintaining the health benefits achieved by the initial behavior changes. Telephone is a viable mode of delivery for maintenance intervention because telephone-delivered interventions can achieve similar effects as face-to-face interventions (Radcliff et al., 2012). Yet telephone delivery has the additional advantages of allowing greater reach, reducing patient burden, and allowing focus on individual barriers and problem solving rather than on the more universal issues covered in a group setting. "
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