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Health benefits and costs of weight-loss dietary counselling by nurses in primary care: a cost-effectiveness analysis

  • Christine L Cleghorn (a1), Nick Wilson (a1), Nisha Nair (a1), Giorgi Kvizhinadze (a1), Nhung Nghiem (a1), Melissa McLeod (a1) and Tony Blakely (a1)...



We aimed to estimate the cost-effectiveness of brief weight-loss counselling by dietitian-trained practice nurses, in a high-income-country case study.


A literature search of the impact of dietary counselling on BMI was performed to source the ‘best’ effect size for use in modelling. This was combined with multiple other input parameters (e.g. epidemiological and cost parameters for obesity-related diseases, likely uptake of counselling) in an established multistate life-table model with fourteen parallel BMI-related disease life tables using a 3 % discount rate.


New Zealand (NZ).


We calculated quality-adjusted life-years (QALY) gained and health-system costs over the remainder of the lifespan of the NZ population alive in 2011 (n 4·4 million).


Counselling was estimated to result in an increase of 250 QALY (95 % uncertainty interval −70, 560 QALY) over the population’s lifetime. The incremental cost-effectiveness ratio was 2011 $NZ 138 200 per QALY gained (2018 $US 102 700). Per capita QALY gains were higher for Māori (Indigenous population) than for non-Māori, but were still not cost-effective. If willingness-to-pay was set to the level of gross domestic product per capita per QALY gained (i.e. 2011 $NZ 45 000 or 2018 $US 33 400), the probability that the intervention would be cost-effective was 2 %.


The study provides modelling-level evidence that brief dietary counselling for weight loss in primary care generates relatively small health gains at the population level and is unlikely to be cost-effective.


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1. Lim, SS, Vos, T, Flaxman, AD et al. (2013) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 22242260.10.1016/S0140-6736(12)61766-8
2. Forouzanfar, MH, Alexander, L, Anderson, HR et al. (2015) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386, 22872323.
3. Ministry of Health (2010) Implementing the Clinical Guidelines for Weight Management in New Zealand 2010/11. Wellington: Ministry of Health.
4. Hartmann-Boyce, J, Johns, DJ, Jebb, SA et al. (2014) Behavioural weight management programmes for adults assessed by trials conducted in everyday contexts: systematic review and meta-analysis. Obes Rev 15, 920932.10.1111/obr.12220
5. Franz, MJ, VanWormer, JJ, Crain, AL et al. (2007) Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 107, 17551767.10.1016/j.jada.2007.07.017
6. Dansinger, ML, Tatsioni, A, Wong, JB et al. (2007) Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med 147, 4150.10.7326/0003-4819-147-1-200707030-00007
7. Brown, I & Psarou, A (2008) Literature review of nursing practice in managing obesity in primary care: developments in the UK. J Clin Nurs 17, 1728.
8. Sargent, G, Forrest, L & Parker, R (2012) Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review. Obes Rev 13, 11481171.10.1111/j.1467-789X.2012.01029.x
9. Segal, L, Dalton, AC & Richardson, J (1998) Cost-effectiveness of the primary prevention of non-insulin dependent diabetes mellitus. Health Promot Int 13, 197209.10.1093/heapro/13.3.197
10. Gillett, M, Royle, P, Snaith, A et al. (2012) Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation: a systematic review and economic evaluation. Health Technol Assess 16, 1236.
11. Forster, M, Veerman, J, Barendregt, J et al. (2011) Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity. Int J Obes (Lond) 35, 10711078.10.1038/ijo.2010.246
12. Blakely, T, Cobiac, LJ, Cleghorn, CL et al. (2015) Health, health inequality, and cost impacts of annual increases in tobacco tax: multistate life table modeling in New Zealand. PLoS Med 12, e1001856.
13. Pearson, AL, Cleghorn, CL, van der Deen, FS et al. (2017) Tobacco retail outlet restrictions: health and cost impacts from multistate life-table modelling in a national population. Tob Control 26, 579585.
14. Van der Deen, FS, Wilson, N, Cleghorn, CL, et al. (2018) Impact of five tobacco endgame strategies on future smoking prevalence, population health and health system costs: two modelling studies to inform the tobacco endgame. Tob Control 27, 278286.
15. Cleghorn, CL, Blakely, T, Kvizhinadze, G et al. (2018) Impact of increasing tobacco taxes on working-age adults: short-term health gain, health equity and cost savings. Tob Control 27, e167e170.
16. Cleghorn, C, Wilson, N, Nair, N et al. (2018) Health benefits and cost-effectiveness from promoting smartphone apps for weight loss: multi-state life-table modeling. JMIR Mhealth Uhealth 7, e11118.10.2196/11118
17. Cleghorn, C, Blakely, T, Mhurchu, CN et al. (2019) Estimating the health benefits and cost-savings of a cap on the size of single serve sugar-sweetened beverages. Prev Med 120, 150156.
18. Cleghorn, C, Blakely, T, Nghiem, N et al. (2017) Technical Report for BODE3 Intervention and Diet MSLT models, Version 1. Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3). Technical Report no. 16. Wellington: University of Otago.
19. University of Otago & Ministry of Health (2011) A Focus on Nutrition: Key Findings of the 2008/09 New Zealand Adult Nutrition Survey. Wellington: Ministry of Health.
21. New Zealand Ministry of Health (2016) Health targets – 2015/16 quarter 1 – results summary. (accessed May 2017).
22. Brotons, C, Ciurana, R, Piñeiro, R et al. (2003) Dietary advice in clinical practice: the views of general practitioners in Europe. Am J Clin Nutr 77, 4 Suppl., 1048S1051S.
23. Wee, CC, Davis, RB & Phillips, RS (2005) Stage of readiness to control weight and adopt weight control behaviors in primary care. J Gen Intern Med 20, 410415.10.1111/j.1525-1497.2005.0074.x
24. Barendregt, J (2012) Ersatz User Guide. Sunrise Beach, QLD: EpiGear International Pty Ltd.
25. McLeod, M, Blakely, T, Kvizhinadze, G et al. (2014) Why equal treatment is not always equitable: the impact of existing ethnic health inequalities in cost-effectiveness modeling. Popul Health Metr 12, 15.10.1186/1478-7954-12-15
26. Flores Mateo, G, Granado-Font, E, Ferré-Grau, C et al. (2015) Mobile phone apps to promote weight loss and increase physical activity: a systematic review and meta-analysis. J Med Internet Res 17, e253.
27. Kang, M, Marshall, SJ, Barreira, TV et al. (2009) Effect of pedometer-based physical activity interventions: a meta-analysis. Res Q Exercise Sport 80, 648655.
28. University of Otago & University of Melbourne (2019) ANZ-HILT: Australia and New Zealand Health Intervention League Table (Vers 2.0). (accessed September 2019).
29. Retat, L, Pimpin, L, Webber, L et al. (2019) Screening and brief intervention for obesity in primary care: cost-effectiveness analysis in the BWeL trial. Int J Obes (Lond). Published online: 31 January 2019. doi: 10.1038/s41366-018-0295-7.
30. Colchero, MA, Rivera-Dommarco, J, Popkin, BM et al. (2017) In Mexico, evidence of sustained consumer response two years after implementing a sugar-sweetened beverage tax. Health Aff (Millwood) 36, 564571.
31. Dhar, T & Baylis, K (2011) Fast-food consumption and the ban on advertising targeting children: the Quebec experience. J Mark Res 48, 799813.
32. Spence, S, Delve, J, Stamp, E et al. (2013) The impact of food and nutrient-based standards on primary school children’s lunch and total dietary intake: a natural experimental evaluation of government policy in England. PLoS One 8, e78298.10.1371/journal.pone.0078298
33. Ananthapavan, J SG, Brown, V, Moodie, M et al. (2018) Assessing Cost-Effectiveness of Obesity Prevention Policies in Australia 2018 (ACE-Obesity Policy). Melbourne: Deakin University.
34. New Zealand Medical Association (2012) Old Primary Health Care MECA 2010–2012. (accessed September 2019).
35. Wilson, N (2014) Technical Report: Estimating the Modelling Parameters Around Dietary Counselling for Preventing Cardiovascular Disease in New Zealand. Wellington: University of Otago.
36. Foster, R, Blakely, T, Wilson, N et al. (2012) Protocol for Direct Costing of Health Sector Interventions for Economic Modelling: Including Event Pathways. Wellington: Department of Public Health, University of Otago.


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Health benefits and costs of weight-loss dietary counselling by nurses in primary care: a cost-effectiveness analysis

  • Christine L Cleghorn (a1), Nick Wilson (a1), Nisha Nair (a1), Giorgi Kvizhinadze (a1), Nhung Nghiem (a1), Melissa McLeod (a1) and Tony Blakely (a1)...


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