Cost-effectiveness of the rural lifestyle eating and activity program (Rural LEAP)

Area of Science:

• Public Health
• Health Economics
• Behavioral Medicine

Background:

• Rural U.S. populations face unique barriers to obesity management and sustained weight loss.
• Telehealth-based behavioral coaching offers a potentially cost-effective solution for extended care.
• Individualized support is crucial for long-term success in weight management programs.

Purpose of the Study:

• To evaluate the cost-effectiveness of telephone-based individual coaching for extended weight loss maintenance in rural adults.
• To compare the outcomes of telephone coaching against an education-only control group over a 5-year period.
• To assess the impact on weight loss categories, Quality-Adjusted Life Years (QALYs), and healthcare costs.

Main Methods:

• A discrete Markov model was used to assess cost-effectiveness over a 5-year horizon, utilizing data from a randomized trial (2013-2018).
• Cost-effectiveness was analyzed from a program and participant perspective, including program costs and participant-reported QALYs and healthcare expenses.
• Sensitivity analyses were performed, and a willingness-to-pay threshold of $150,000/QALY was applied.

Main Results:

• The intervention group (18 telephone counseling sessions) showed higher effectiveness, with 34.2% achieving at least 10% weight loss versus 17.0% in the control group at the end of the intervention.
• At 5 years post-intervention, 6.4% of modeled intervention participants were predicted to maintain at least 10% weight loss, compared to 5.4% for controls.
• Intervention participants had modestly lower out-of-pocket medical costs, partially offsetting the higher coaching program costs, with Incremental Cost-Effectiveness Ratios (ICERs) ranging from $7,731 to $8,156 per QALY gained.

Conclusions:

• Telephone-based individual coaching is a cost-effective strategy for supporting long-term weight management in rural populations.
• This telehealth intervention demonstrates potential for improving sustained weight loss and health outcomes, contributing to disease prevention efforts.
• Findings support the integration of tailored, accessible behavioral coaching into public health strategies for obesity management.