Health economic evaluation of weight reduction interventions in individuals suffering from overweight or obesity and a musculoskeletal diagnosis-a systematic review

• Published in: BMC musculoskeletal disorders Vol. 25; no. 1; pp. 744 - 18
• Main Authors: Schurz, Alexander P, Walter, Matthias M, Liechti, Melanie, Clijsen, Ron, Deliens, Tom, Taeymans, Jan, Lutz, Nathanael
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16-09-2024; BioMed Central; BMC
• Subjects: Back pain; Body mass index; Body weight; Body weight loss; Care and treatment; Check lists; Chronic illnesses; Citation indexes; Comorbidity; Complications and side effects; Cost analysis; Cost-Benefit Analysis; Cost-effectiveness analysis; Demographic aspects; Diagnosis; Economic aspects; Economics; Evaluation; Exercise Therapy - economics; Exercise Therapy - methods; GDP; Gross Domestic Product; Health care; Health Care Costs - statistics & numerical data; Health care expenditures; Health economic evaluation; Humans; Intervention; Medical economics; Meta-analysis; Musculoskeletal diseases; Musculoskeletal Diseases - diagnosis; Musculoskeletal Diseases - economics; Musculoskeletal Diseases - therapy; Obesity; Obesity - diagnosis; Obesity - economics; Obesity - therapy; Osteoarthritis; Overweight; Overweight - economics; Overweight - therapy; Purchasing power parity; Quality of life; Quality-Adjusted Life Years; Reviews; Risk factors; Sensitivity analysis; Systematic Review; Weight control; Weight Loss; Weight reduction programs; Weight Reduction Programs - economics; Weight Reduction Programs - methods; Belgium; United States > US; Europe; Musculoskeletal diseases; Cost-effectiveness analysis; Health economic evaluation; Weight loss; Overweight; Weight reduction programs
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-024-07861-9

Most of the worldwide population is overweight and suffers from the resulting musculoskeletal comorbidities such as knee osteoarthritis or back pain. Practice guidelines recommend weight loss interventions for individuals suffering from these conditions. This systematic review investigated whether including a weight loss intervention in the musculoskeletal therapy of these individuals was cost-effective compared to administering the musculoskeletal therapy alone.
This study followed the PRISMA guidelines to systematically and independently search six databases and select full health economic evaluations published up to May 2024 from health care or societal perspectives according to predefined eligibility criteria. Cost data were standardised to 2023 Belgium Euros. The methodological quality was assessed using two health economic-specific checklists.
The searches produced 5'305 references, of which 8 studies were selected for a total of 1'726 participants. The interventions consisted of different exercise plans and nutritional targets. Six values were in the north-eastern; leading to increased quality-adjusted life year (QALY) and higher costs; and two in the south-eastern quadrant of the cost-utility plane; leading to increased QALYs and lower costs. Two studies observed no differences in QALYs. Incremental cost utility ratios (ICUR) ranged from €13'580.10 to €34'412.40 per additional QALY from a healthcare perspective. From a societal perspective, the ICUR was €30'274.84. The included studies fulfilled 86 percent of the criteria in trial-based economic evaluations and 57 percent in model-based economic evaluations. The most common limitations of the studies were related to appropriate cost measures' specifications, research questions, time horizon choices, and sensitivity analyses.
This systematic review showed weak but consistent evidence of cost-effectiveness for adding a weight loss intervention to musculoskeletal therapy for individuals with overweight, from either perspective. Further economic evaluations should evaluate the long-term cost-effectiveness of the intervention.
International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY (2022,110,122).