Cost-effectiveness of a community-based, diabetes prevention program targeting a low SES Mexico-origin population

Background Rates of type 2 diabetes in Texas-Mexico border counties (20-39%) exceed national rates. Few community-based interventions have improved outcomes related to risk factors (overweight, sedentary lifestyle, and poor diet) in low-income Mexican-American populations. Further, information on intervention cost-effectiveness is lacking. We evaluate the cost-effectiveness of a 12-week community-based, culturally-relevant intervention aimed at improving dietary and physical activity behaviors, targeting a Mexican-American population in South Texas.

Methods We segmented the sample available at follow-up (n=341) into BMI categories and calculated the portion of each group losing 2% and 5% body weight over nine months. We calculated costs on an intent-to-treat basis. We forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining 2% and 5% weight loss goals. We projected outcomes out 10 and 20 years.

Results The sample was predominantly female (81%), born in Mexico (77%), low-income, and middle-aged; 17% were normal weight; 41% were obese. Overall, 34% of the sample experienced at least 2% weight loss and 13% achieved at least 5% weight loss over nine months. The intervention was cost-effective over a 20-year time horizon for all groups in both scenarios with costs per QALY gained of $60,787 (2%) and $62,236 (5%), respectively. It was most cost-effective for the morbidly obese under the 5% / 20-year horizon scenario at $46/QALY.

Discussion The intervention's 2% weight loss results compare favorably to other community-based weight loss interventions. We demonstrate that culturally-appropriate community weight loss interventions can be highly cost-effective, especially for the morbidly obese.