Which is more effective in helping people who are at high risk for diabetes avoid the disease: a face-to-face “lifestyle intervention”? An Internet-based version? The same thing on a DVD? Or letting patients choose the version they want to pursue? And when you factor in the costs, which one is most cost-effective?
The prospective Rethinking Eating and ACTivity (REACT) study enrolled 434 overweight adults with abdominal obesity in eight rural communities in southwestern Pennsylvania. Already I’m thinking, not exactly Silicon Valley, but what do I know about their technological experience?
Participants were randomized to one of four groups with various versions of a “group lifestyle balance” program that aimed to educate them about physical activity, weight loss techniques, and other ways to make healthy changes to their lifestyles. The face-to-face version (119 people) involved weekly group education sessions for 12 weeks. The 113 participants in the DVD group watched 12 group lifestyle balance sessions on DVD and met with healthcare workers four times for debriefing about the DVDs. The Internet group (101 people) experienced 12 group lifestyle balance sessions that were incorporated into an online format with blogging and e-mail capabilities.
The final 101 participants were randomized to a “self-selection” group that allowed each person to decide which format to use. Sixty percent chose the Internet program, 40% chose face-to-face group meetings, and not a single person picked the DVD. (Sign of the times? I think I’ll put my CD/DVD shelves on eBay before they become worthless.)
The good news is that all versions of the lifestyle intervention worked, said Shihchen Kuo of the university’s department of epidemiology, who focused on a cost-effectiveness analysis. Elsewhere at the meeting, his associates presented separate analyses of 6-month follow-up data suggesting that letting patients choose the type of program provided the best outcomes. Participants in the self-selection group showed the largest improvements in physical and mental functioning and were 1.5 times less likely to have impaired fasting glucose compared to the other groups, though at least half of each group met the goal of losing 5% of their weight. Among those who lost weight, 80% kept it off at the 6-month follow-up, according to a university press release.
But effectiveness is only half the story when setting policy. Cost is the other half. Using preliminary data from the first 3 months of follow-up to model results at 3 and 5 years, the face-to-face program dominated the others in cost-effectiveness, Mr. Kuo reported. Adherence rates were 76% in the face-to-face program, 57% with the DVD, 53% in the self-selection group, and 38% using the Internet. The Internet-based program cost the most to operate, he said.
Projected out to 5 years, the face-to-face program would cost $63,377 per quality-adjusted life year compared with no intervention, he estimated, well within the range of many commonly accepted medical interventions.
It will be interesting to see if the cost-effectiveness results change when considering 6-month outcomes and become more closely aligned with the 6-month results for effectiveness. For now, though, “the face-to-face group lifestyle balance strategy delivered in rural communities is a sound investment” when choosing between the three models, Mr. Kuo concluded, “and appears to be economically reasonable” compared with doing nothing.
For those of you keeping score at home, I’d call this a tie — Humans 1, Technology 1. Would you agree?
–Sherry Boschert (@sherryboschert on Twitter)