Five-year medical and pharmacy costs after a medically supervised intensive treatment program for obesity.

PURPOSE

The financial impact of intensive medical interventions for weight loss has not been fully studied.

DESIGN

A randomized pragmatic clinical trial.

SETTING

Seven primary care clinics and one research center in Louisiana.

SUBJECTS

Severely obese individuals (body mass index 40-60 kg/m(2)) randomized to usual care (n = 190) or intensive medical management (n = 200). Forty-seven percent of participants completed year 2 follow-up and were included in the analyses.

INTERVENTION

Physician-monitored intervention with recommendations for 12 weeks of liquid diet followed by 4 months of group behavioral therapy, structured diet, and option of pharmacotherapy, and an additional 16 months of maintenance strategies.

MEASURES

Two-year preintervention and 5-year postintervention measures were computed from claims data and included (1) medical costs excluding pharmacy, (2) pharmacy costs only, (3) total medical and pharmacy costs, and (4) medical and pharmacy subcategory costs.

ANALYSIS

Differential categories for preintervention and postintervention were created using total sample 75th percentiles. Chi-square tests were employed to compare the intervention groups both preintervention and postintervention with respect to the proportion of subjects above the 75th percentile for each of the cost categories.

RESULTS

Medical costs excluding pharmacy did not differ between groups. The intensive medical intervention group had a significantly smaller percentage of subjects above the 75th percentile for pharmacy costs only (p = .0125), and for antidiabetic agents (p = .0464), antihypertensives (p = .0075), and dyslipidemic subcategories (p = .0197).

CONCLUSION

An intensive medical intervention may reduce pharmaceutical expenditures in severely obese individuals. These results must be viewed with caution given the high attrition of study participants.