Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes


Espeland MA, Glick HA, Bertoni A, et al; for the Look AHEAD Research Group. Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: The Action for Health in Diabetes. Diabetes Care. 2014;37:2548-2566.

Look AHEAD enrolled 5,145 overweight or obese subjects with type 2 diabetes; subjects were randomly assigned to intensive lifestyle intervention (ILI) or diabetes support and education (DSE) to assess the long-term effects of these interventions on cardiovascular morbidity and mortality.

  

Commentary Thumb Inzucchi Look AHEAD 

The present analysis evaluated whether behavioral intervention targeting weight loss and increased physical activity influences long-term healthcare use and costs. The primary outcomes were annual rate and cost of healthcare use, and per-participant 10-year cumulative mean discounted costs.

 

Lifestyle Reduced Healthcare Use & Costs 

Significant reductions in hospitalization (11%; P=0.004), days in hospital (15%; P=0.01), rehab and long-term care (14%; P=0.05), home care (16%; P=0.001), and prescription medication (6%; P<0.001) were seen among subjects randomized to intensive lifestyle intervention compared with diabetes support and education.

 
The average annual cost of healthcare services and medications was 7% less among subjects randomized to intensive lifestyle interventions vs diabetes support and education ($8,321 vs $8,916; P=0.002):
  • 10% ($283) lower per-participant average annual costs for hospitalization (P=0.04)
  • 7% ($281) lower annual medication cost (P<0.0001)
 There was no significant difference in the average annual cost of outpatient services.

Impact on 10-year Costs 

Total 10-year discounted cumulative costs were reduced by $5,280 (95% CI, $3,385-$7,715) in the intensive lifestyle intervention group. Hospitalization costs were reduced by $2,567 (95 % CI, $954–$4,180) in the ILI group.
  • Medication costs were reduced by $2,474 (95% CI, $2,047–$2,901) in the ILI group
  
  • The rate at which costs accumulated increased with time.
    • Healthcare costs associated with obesity and diabetes accelerate in later life.
     
  • The savings in total medical care costs associated with ILI accrued gradually over time.
  • Differences in discounted outpatient service costs were lower ($239 [95% CI -$267 to $745]).
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Look AHEAD Intensive Lifestyle Intervention Reduces Costs Over 10 Years  
Look AHEAD: Intensive Lifestyle Intervention Reduces Costs Over 10 Years 

Total Costs 

  • In this healthcare utilization and cost analysis of Look AHEAD:
    • For subjects without CVD history, ILI was associated with significantly lower costs for outpatient care and medications, and total costs
    • For subjects with CVD history, ILI was associated with greater outpatient costs
     
  • The savings on overall medical costs associated with ILI did not depend on participant age, BMI, sex, or race/ethnicity.
  • The ILI effect on hospitalization costs did not differ between those who had or did not have a history of cardiovascular disease.
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Look AHEAD Total Costs Differ Significantly According to Baseline History of Cardiovascular Disease  
Look AHEAD: Total Costs Differ Significantly According to Baseline History of Cardiovascular Disease 

Summary 

  • In this healthcare utilization and cost analysis of Look AHEAD, intensive lifestyle intervention focused on weight loss and increased physical activity, as opposed to diabetes support and education, resulted in:
    • Fewer hospitalizations
    • Fewer days in the hospital
    • Less use of prescription medications compared with support and education
    • Cumulatively, these effects resulted in an average annual savings of almost $600 per participant
     
  • Intensive lifestyle intervention may be most beneficial to overweight and obese individuals with diabetes before cardiovascular disease is evident.
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Look AHEAD Healthcare Utilization and Cost Analysis Summary  
Look AHEAD Healthcare Utilization and Cost Analysis: Summary 
 
 
Look AHEAD=Action for Health in Diabetes

Related content: 

For more content on Look AHEAD, click here 

  

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States. 

October 2014 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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Last Modified: 12/9/2014