Cost-effectiveness analysis of a low-fat diet in the prevention of XXXX .

@entity1 @entity3918 @entity0 @entity5344
BACKGROUND: Results of the @entity1 's Health Initiative Randomized Controlled Dietary Modification Trial (WHI- @entity3918 ) suggest that a low-fat diet may be associated with beneficial health outcomes for specific groups of @entity1 . OBJECTIVE: The objective is to assess how cost-effective the WHI- @entity3918 would be if implemented as a public health intervention and under the sponsorship of private health insurers and Medicare. @entity5344 are the health outcomes of interest. @entity1 : Two groups of WHI- @entity3918 @entity1 form the target population for this analysis: @entity1 consuming >36.8% of energy from fat at baseline, and @entity1 at high risk for @entity0 with 32% or more of energy from fat at baseline. METHODS: This study uses Markov cohort modeling, following societal and health care payer perspectives, with Monte Carlo simulations and one-way sensitivity analyses. WHI- @entity3918 records, nationally representative prices, and published estimates of medical care costs were the sources of cost information. Simulations were performed for hypothetical cohorts of @entity1 aged 50, 55, 60, 65, or 70 years at the beginning of the intervention. Effectiveness was estimated by quality-adjusted life years (QALYs) and the main outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS: Following the societal perspective, the ICERs for the 50-year old cohort are  13,773/QALY (95% confidence interval  7,482 to  20,916) for @entity1 consuming >36.8% of energy from fat at baseline and  10,544/QALY ( 2,096 to  23,673) for @entity1 at high risk for @entity0 . The comparable ICER from a private health care payer perspective is  66,059/QALY ( 30,155 to  121,087) and from a Medicare perspective, it is  15,051/QALY ( 6,565 to  25,105). CONCLUSIONS: The WHI- @entity3918 is a cost-effective strategy for the prevention of @entity5344 in the target population, from both societal and Medicare perspectives. Private health care payers have a relative short timeframe to realize a return on investment, since after age 65 years the financial benefits associated with the prevention program would accrue to Medicare. For this reason, the intervention is not cost-effective from a private health care payer perspective.
