Is doctor referral to a low-energy total diet replacement programme cost-effective for the routine treatment of obesity?

ObjectiveThe study objective was to estimate the cost‐effectiveness of a commercially provided low‐energy total diet replacement (TDR) program compared with nurse‐led behavioral support. Methods A multistate life table model and the weight reduction observed in a randomized controlled trial were used to evaluate the quality‐adjusted life‐years and direct health care costs (in United Kingdom 2017 prices) over a lifetime with TDR versus nurse‐led support in adults who had obesity, assuming that (i) weight returns to baseline over 5 years and (ii) a 1‐kg weight loss is maintained after 5 years following TDR. Results The per‐person costs of the TDR and nurse‐led programs were £796 and £34, respectively. The incremental cost‐effectiveness ratio of TDR was £12,955 (95% CI: £8,082‐£17,827) assuming that all weight lost is regained and £3,203 (£2,580‐£3,825) assuming that a 1‐kg weight loss is maintained after 5 years. TDR was estimated to be more cost‐effective (i.e., lower incremental cost‐effectiveness ratios) in older adults and those with a higher BMI, with little difference by gender. Conclusions At current retail prices and with plausible long‐term weight regain trajectories, TDR is projected to be cost‐effective in adults with obesity and could be considered as an option to treat obesity in routine health care settings