Pills vs. Programs

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It has often been observed that our health-care system is designed, first and foremost, to provide treatment for acute conditions — that is, conditions that can be treated and cured, leaving the patient healthy until the next illness or malady comes along. Chronic conditions such as Type 2 diabetes and obesity often receive less attention than they deserve, given that they account for a large share of health-care costs in the United States and many other industrialized countries. For example, many insurance plans will cover only a few hours of diabetes education, while fully covering amputations due to diabetic complications — potentially spending more money than they would if they could reduce diabetic complications by covering intensive diabetes education.

As health-care costs have grown in recent years, researchers and policymakers have been interested in studying the potential costs and benefits of lifestyle-intervention programs. One such study, focused on weight loss, was recently conducted by researchers at the Duke–National University of Singapore Medical School. Published in the journal Obesity, the study compared the costs and effectiveness of various weight-loss programs and prescription weight-loss drugs. As noted in an ABC News article on the study, it included programs and drugs with proven weight-loss benefits a year after beginning the treatment. Programs included were Weight Watchers, Jenny Craig, and now-defunct Vtrim; drugs included phentermine and topiramate (brand name Qsymia), lorcaserin (Belviq), and orlistat (Xenical, alli).

Overall, Weight Watchers was found to be the most cost-effective intervention, costing $155 for every kilogram (2.2 pounds) of body weight lost, on average, a year into the study. But Jenny Craig resulted in the greatest overall weight loss, with participants losing an average of 7.4 kilograms (16.3 pounds), compared with 2.4 kilograms (5.3 pounds) for Weight Watchers. The average annual cost of Weight Watchers was $377, while Jenny Craig’s average annual cost was over $2,500 due to the high cost of its food. Weight-loss drugs fell somewhere between the two programs in terms of both average cost and average weight loss: orlistat came in at $1,518 and 2.8 kilograms (6.2 pounds), or $546 per kilogram lost; lorcaserin came in at $1,743 and 3.2 kilograms (7 pounds), or $545 per kilogram lost; and phentermine and topiramate came in at $1.336 and 6.7 kilograms (16.8 pounds), or $204 per kilogram lost.

Whether insurance plans should cover weight-loss programs, in addition to weight-loss drugs, remains a topic of some controversy. Most weight-loss drugs are designed to help people who are severely obese, while commercial weight-loss programs tend to be targeted toward the much larger overweight population. And there is little precedent for health insurance covering the specially prepared foods that are part of some weight-loss programs. Furthermore, for both drugs and weight-loss programs, health insurers have little guidance regarding how different amounts of weight loss affect both overall health and future cost savings.

There is, however, solid evidence that for people with diabetes, good blood glucose control can prevent many future diabetes complications. There is no lifestyle- and support-based intervention program for Type 2 diabetes on the scale of Weight Watchers or Jenny Craig. Given recent recommendations that a carbohydrate-restricted diet be the centerpiece of Type 2 diabetes treatment, and the proven difficulty in maintaining such a diet, it seems logical that if a Type 2 diabetes lifestyle and support program were shown to be effective at reducing diabetes complications, health insurance should cover it.

What do you think — should lifestyle-intervention programs be considered a valid medical treatment, just like prescription drugs? Should health insurers consider only cost savings when deciding what preventive treatments to cover, or should they be compelled to pay for expensive drugs or programs that may be better at treating obesity or diabetes, but not save money? Would you be interested in an intensive lifestyle-intervention and support program for diabetes if your insurance covered it? Leave a comment below!

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