Month: July 2019

“Studies like ours, which provide reliable estimates of the long-term impacts of weight management programmes on patients’ health and healthcare costs, are of real importance to enable the NHS to select the most clinically and cost-effective services for their patients.”[1]

Seamus Kent, health economist at the University of Oxford, presents his findings concerning the cost effectiveness of total diet replacement programmes (TDRs) in the DROPLET study, in which patients are referred to a TDR by their doctor, compared with nurse-led behavioural support.

The results

Compared with regular weight loss support from a practice nurse, a programme of weekly behavioural support and TDR seems to be tolerable and leads to substantially greater weight loss. At current retail prices and with plausible long‐term weight regain trajectories, TDR is projected to be cost‐effective in adults with obesity and should be considered as an option to treat obesity in routine health care settings.

he study estimated that, for every 100,000 people referred to the TDR programme, 50 coronary heart disease events, 75 strokes, 900 cases of type 2 diabetes, and 25 cancers could be avoided. As a result, people are expected to live longer and in better health, with lower use and costs of healthcare services. The TDR programme is expected to cost an additional £13,000 for every year of life lived in full health which is gained as a result of the treatment. In the UK, healthcare interventions are generally considered cost-effective if they provide such a benefit for less than £20,000.

Reactions to the study

Following these results, Professor Susan Jebb, Professor of Diet and Population Health in University of Oxford’s Nuffield Department of Primary Care Health Sciences, Chief investigator of the DROPLET trial, said: “It is great to see the NHS Long Term Plan taking this research evidence and translating it into new clinical services for people who are obese. Our study provides great confidence that this programme is a cost-effective treatment, which could improve the health of large numbers of people who are affected by obesity.”

Professor Anthony Leeds, chairman of TDMR Europe, said of the results of the study: “We very much welcome the results of this study. Health care costs are higher among older and heavier people, so it is not a surprise to find that GP referral to a Total Diet Replacement (TDR) programme delivered in the community is most cost effective among those over 50 years and those with a BMI over 35. This fits with the typical age and weight of people with Type 2 diabetes, osteoarthritis and other obesity-related co-morbidities.”

[1] Kent, 2019, https://www.clahrc-oxford.nihr.ac.uk/news/low-calorie-meal-replacements-are-a-cost-effective-routine-treatment-for-obesity-in-the-nhs

 

“The DROPLET trial showed that after 12 months people on total diet replacements lost on average 10.7kg (1 stone, 9lb), which was 7.2kg (1 stone, 1 lb) more than those only receiving the standard nurse-led programme of weight loss advice. This new analysis adds to that finding by strongly suggesting it’s also a cost-effective treatment for the NHS to offer, particularly in middle-aged and older adults.”

Dr Nerys Astbury, senior researcher at the department of primary care at the University of Oxford, is interested in how dietary manipulations affect weight management and the regulation of energy intake. She is currently working on developing a weight loss toolkit which will utilise total diet meal replacements (TDRs) to help people manage their weight, including for the attenuation of weight gain during pregnancy. Her previous research has shown that TDRs followed by food reintroduction and a solid maintenance programme can be used effectively in a community setting after being referred by a GP practitioner.

The DROPLET trial successfully demonstrates that TDRs are an acceptable form of treatment to be delivered in routine care after a referral

Dr Astbury discusses what makes the DROPLET trial different from its predecessors. Previously, trials involving TDRs for diabetics and overweight patients have been carried out in controlled situations, such as intense research settings or specialist obesity clinics. The DROPLET trial successfully demonstrates that TDRs are an acceptable form of treatment to be delivered in a community setting after referral in routine care.

So, what does the future hold for TDRs? Co-payment as a solution to offset some of the cost of the treatment

Dr Astbury says that, given the results of the DROPLET study and others that have come before it – particularly the DiRect study led by Professor Mike Lean – we know that TDRs can be an effective treatment for obesity and Type 2 diabetes. As a result of this, the NHS has committed to piloting a scheme for 5000 people to trial the use of TDRs. Dr Astbury admits that payment of the programmes may be an issue, suggesting co-payment as a possible solution. Co-payment is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service, to offset some of the cost of the treatment. In the UK, eye care and dental care have already set the precedent for co-payments.

More investment in research is needed to further explore effective treatments, but also focus on prevention

Dr Astbury advises that we should be investing more in research, in order to discover new and effective treatments to tackle obesity and its related problems. But as well as innovative treatments, it is important to investigate preventative measures that stop people become overweight and obese in the first place.

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