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Economic evaluation of a weight control program with e-mail and telephone counseling among overweight employees: a randomized controlled trial

Marieke F van Wier1234, J Caroline Dekkers1345, Judith E Bosmans36, Martijn W Heymans236, Ingrid JM Hendriksen47, Nicolaas P Pronk8, Willem van Mechelen134* and Maurits W van Tulder236

Author Affiliations

1 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands

2 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

3 EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands

4 Body@Work, Research Center Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands

5 Municipal Health Service, The Hague, The Netherlands

6 Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands

7 TNO Quality of Life, Leiden, The Netherlands

8 HealthPartners, JourneyWell and HealthPartners Research Foundation, Minneapolis, MN, USA

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International Journal of Behavioral Nutrition and Physical Activity 2012, 9:112  doi:10.1186/1479-5868-9-112

Published: 11 September 2012



Distance lifestyle counseling for weight control is a promising public health intervention in the work setting. Information about the cost-effectiveness of such interventions is lacking, but necessary to make informed implementation decisions. The purpose of this study was to perform an economic evaluation of a six-month program with lifestyle counseling aimed at weight reduction in an overweight working population with a two-year time horizon from a societal perspective.


A randomized controlled trial comparing a program with two modes of intervention delivery against self-help. 1386 Employees from seven companies participated (67% male, mean age 43 (SD 8.6) years, mean BMI 29.6 (SD 3.5) kg/m2). All groups received self-directed lifestyle brochures. The two intervention groups additionally received a workbook-based program with phone counseling (phone; n=462) or a web-based program with e-mail counseling (internet; n=464). Body weight was measured at baseline and 24 months after baseline. Quality of life (EuroQol-5D) was assessed at baseline, 6, 12, 18 and 24 months after baseline. Resource use was measured with six-monthly diaries and valued with Dutch standard costs. Missing data were multiply imputed. Uncertainty around differences in costs and incremental cost-effectiveness ratios was estimated by applying non-parametric bootstrapping techniques and graphically plotting the results in cost-effectiveness planes and cost-effectiveness acceptability curves.


At two years the incremental cost-effectiveness ratio was €1009/kg weight loss in the phone group and €16/kg weight loss in the internet group. The cost-utility analysis resulted in €245,243/quality adjusted life year (QALY) and €1337/QALY, respectively. The results from a complete-case analysis were slightly more favorable. However, there was considerable uncertainty around all outcomes.


Neither intervention mode was proven to be cost-effective compared to self-help.

Trial registration


Body weight; Cost-effectiveness; Cost-utility; Distance counseling; Intervention; Lifestyle; RCT; Workplace health promotion