Effects of Lifestyle Intervention on Health Care Costs: Improving Control with Activity and Nutrition (ICAN)
Abstract
Objective
To evaluate program and health care costs of a lifestyle intervention in a high-risk obese population.
Design
Twelve-month randomized controlled trial comparing lifestyle case management to usual care.
Subjects/setting
Health plan members (n=147) with obesity (body mass index ≥27) and type 2 diabetes.
Intervention
Lifestyle case management entailed individual and group education, support, and referrals by registered dietitians. Those in the usual-care group received educational material.
Main outcome measures
Medical and pharmaceutical health care costs reimbursed by the participant’s primary insurance company.
Statistical analysis
Total costs were modeled using the four-equation model using previous year cost as a predictor.
Results
Net cost of the intervention was $328 per person per year. After incorporating program costs, mean health plan costs were $3,586 (95% confidence interval [CI]: −$8,036, −$25, P<0.05) lower in case management compared to usual care. The difference was driven by group differences in medical (−$3,316, 95% CI: −$7,829 to −$320, P<0.05) but not pharmaceutical costs (−$239, 95% CI: −$870 to $280, not statistically significant), with fewer inpatient admissions and costs among case management compared with usual care (admission prevalence: 2.8% vs 22.5% respectively, P<0.001).
Conclusion
Addition of a modest-cost, registered dietitian–led lifestyle case-management intervention to usual medical care did not increase health care costs and suggested modest cost savings among obese patients with type 2 diabetes. Larger trials are needed to determine whether these results can be replicated in a broader population. The findings can be judiciously applied to support that the addition of a registered dietitian–led lifestyle case-management program to medical care does not increase health care costs.
Address correspondence to: Anne M. Wolf, MS, RD, Instructor of Research, Department of Public Health Sciences, 1710 Allied St, Suite 34, Charlottesville, VA 22903.
ABSTRACT
Effects of Lifestyle Intervention on Health Care Costs: Improving Control with Activity and Nutrition (ICAN)