No decrease in Medicare spending after Look AHEAD lifestyle intervention
Click Here to Manage Email Alerts
Among participants in the Look AHEAD trial of an intensive lifestyle intervention for weight loss, there was no difference in total Medicare spending between the intervention and control group over a 4-year period, according to study data.
“While the Look AHEAD intensive lifestyle intervention reduced weight, improved diabetes control, and reduced health care use and spending for the intensive lifestyle intervention vs. the control group during the intervention period, we found no difference between arms in total Medicare spending, hospitalizations or ED use in the years immediately following the intervention,” Peter J. Huckfeldt, PhD, associate professor at the University of Minnesota School of Public Health, told Healio. “We found lower Part D prescription drug costs, but this difference also became insignificant by 2014 and 2015. Our results suggest that reductions in health care use and spending from successful lifestyle intervention may not persist after the interventions end.”
Huckfeldt and colleagues published their findings in JAMA Network Open.
Researchers conducted an ancillary study with participants from Look AHEAD, a randomized trial examining the association between intensive lifestyle intervention and weight loss for individuals with type 2 diabetes. Look AHEAD participants who consented to have their Medicare records linked were included in the study. A total of 2,796 participants were included in the study, with 1,409 from intervention group and 1,387 from the control group.
The Medicare Master Beneficiary Summary File was used to determine participant eligibility, Medicare Advantage enrollment and spending by service category. Data on hospital admission and ED use were compiled from the 2012 to 2014 Healthcare Effectiveness Data and Information Set. Researchers compared visits and costs between the intervention and control cohorts in the final year of Look AHEAD in 2012 and the 3 years after the conclusion of the trial from 2013 to 2015.
The intensive lifestyle intervention and control groups were similar in age and sex. The linked intervention cohort had similar associations with weight and HbA1c when compared with all participants in Look AHEAD. Compared with the control group, the intervention group had a mean weight reduction of 1.9% during the sample period from 2012 to 2015 (95% CI, –2.6 to –1.2; P < .001). There was no difference in the annual number of hospital admissions or ED visits between the two groups.
The intervention and control groups had no mean difference in total Medicare spending. No difference was found in Part A spending between the two groups. The lifestyle intervention group had higher Part B spending than control (adjusted difference, $513; 95% CI, 70-955; P = .02), but lower mean Part D prescription drug costs (adjusted difference, –$803; 95% CI, –1,522 to –83; P = .03) and lower mean Part D out-of-pocket spending (adjusted difference, –$196; 95% CI, –383 to –8; P = .04).
“As far as we know, there is no other research directly estimating whether successful lifestyle interventions can affect long-term health care use and spending post-intervention,” Huckfeldt said. “Prior work has used simulation-based approaches that rely on some strong assumptions. Thus, this was really an open question, and I think our main finding is quite novel as a result.”
Huckfeldt said future research should examine whether the reason for hospitalization differed between the two groups, how the type of drugs were different between the cohorts, and to follow the participants in the coming years to analyze long-term health care spending.
For more information:
Peter J. Huckfeldt, PhD, can be reached at huckfeld@umn.edu.
Collapse
Read more about
Click Here to Manage Email Alerts