Cost-effectiveness of a faith-based lifestyle intervention for diabetes prevention among African Americans: A within-trial analysis

• Type of Material: Article
• Authors: Elizabeth C. Rhodes, Emory University; Eeshwar K. Chandrasekar, Emory University; Shivani Patel, Emory University; K.M. Venkat Narayan, Emory University; Thomas V. Joshua, Augusta University; Lovoria B. Williams, Augusta University; Lucy Marion, Augusta University; Mohammed Ali, Emory University
• Language: English
• Date: 2018-12-01
• Publisher: ELSEVIER IRELAND LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.diabres.2018.09.016
• Title of Journal or Parent Work: DIABETES RESEARCH AND CLINICAL PRACTICE
• Volume: 146
• Start Page: 85
• End Page: 92
• Grant/Funding Information: This work was supported by the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases [grant number R18DK082401], National Heart, Lung, And Blood Institute [grant number R01HL125442], and Fogarty International Center [grant number R25Tw09337].; MKA and KMVN are partially supported by the Georgia Center for Diabetes Translation Research funded by the National Institute of Diabetes and Digestive and Kidney Diseases [grant number P30DK111024].
• Keywords: CHINA; FOLLOW-UP; Cost; Diabetes prevention; TRANSLATION; African American; Endocrinology & Metabolism; Lifestyle intervention; Obesity; Church; Science & Technology; HEALTH; RISK; Life Sciences & Biomedicine; PROGRAM
• Research Categories: Health Sciences, Public Health

Abstract

Aims: We assessed costs and cost-effectiveness of implementing Fit Body and Soul (FBAS), a church-based 18-session lifestyle education intervention for African Americans. Methods: We calculated incremental cost-effectiveness ratios (ICER) using data from a cluster randomized controlled trial comparing FBAS with health education (HE) among 604 overweight participants in 20 churches. The ICER was the adjusted difference in costs to deliver FBAS versus HE over the difference in weight change (kilograms [kg]) at one-year follow-up. Costs included those incurred for participant identification and program implementation. We fitted linear mixed-effects regression models, accounting for clustering of participants within churches and for age, sex, and educational attainment. We repeated these analyses for secondary outcomes (waist circumference [cm], physical activity [MET], glucose, blood pressure, and quality of life). Results: Per-person intervention cost of FBAS was $50.39 more than HE ($442.22 vs. $391.83 per-person), and adjusted differences in weight change (1.9 kg [95% CI: 1.0 to 2.8]) and waist circumference (2.4 cm [95% CI: 1.3 to 3.4]) were both significant. FBAS did not result in statistically significant differences in physical activity, glucose, blood pressures, or quality of life. We estimated that compared to HE, FBAS costs an additional $26.52 per kg weight lost and $21.00 per cm reduction in waist circumference. Conclusions: For a modest increase in cost, FBAS led to greater weight and waist reductions among African Americans in a church setting. ClinicalTrials.gov Identifier NCT01730196.