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Cost Effectiveness of Two Lifestyle Interventions in the Vermont WISEWOMAN Program


A flow chart describes the movement of the Vermont WISEWOMAN program from a first box showing its impetus, public health concern about cardiovascular health and obesity. An arrow connects that box to one listing 3 health and intervention success factors studied: household income, Ladies First program membership, and the participant’s geographic location. An arrow connects that box to the intervention arms, 2 evidence-based weight loss programs: Curves Complete and Weight Watchers. An arrow flows from this box: one to a box listing essential partnerships within the Vermont Department of Health (WISEWOMAN program, Public Health Statistics Section, and Business Office) and program support from the WISEWOMAN program at the Centers for Disease Control and Prevention. A second arrow links with a box describing the program’s evaluation approach, which operates independently from the program and includes a comparison of costs (in USD) and benefits (in weight loss units) of alternative interventions to determine the most efficient allocation of scarce resources. Arrows flow from both of these boxes to a box showing the 2 program outcomes of interest, 1) the cost per participant completing the intervention and 2) the cost per participant meeting her weight loss goal.

Figure 1.
The Vermont WISEWOMAN program and connections among its various components. The program’s objective was improvement of cardiovascular health through weight loss. Abbreviation: WISEWOMAN, Well Integrated Screening and Evaluation for Women Across the Nation.

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A flow chart begins with a box labeled “Screenings and Medical Support”: conduct CVD screenings and health risk assessments; provide medical support, as needed; and address uncontrolled hypertension. That box is attached to a satellite box describing delivery by health care providers with systems that optimize control of hypertension, such as treatment protocols, team-based care, delivery system design, and health IT/EHR. The first box connects with a box listing components of patient-centered risk reduction counseling: give screening results both verbally and in writing, provide interpretations and recommendations, use motivational interviewing, and facilitate access to medical follow-up and healthy behavior support services. An arrow connects that box with 2 boxes, one labeled “Ready,” which leads to a large box labeled “Healthy Behavior Support Services,” and one labeled “Not Ready.” An arrow runs from the Not Ready box to a box labeled “Call Back at a Later Date” followed by an arrow back to “Healthy Behavior Support Services.” The box labeled “Healthy Behavior Support Services” also says to refer women to the option that best supports the woman’s goals. The 3 options are in boxes labeled Health Coaching, ongoing coaching sessions to improve or maintain health; Lifestyle Programs, evidence-based programs in the community to promote and sustain healthy behaviors; and Community-Based Referrals, community resources that support healthy behaviors. All 3 boxes connect to a box labeled Follow Up, interim assessment of patient progress and reinforcement of goals. An arrow flowing from this last box is labeled “Rescreen 12 to 18 months after initial screening” and ends back at the start of the chart, Screenings and Medical Support.

Figure 2.
Flow of service delivery for Vermont WISEWOMAN illustrating the process by which eligible women moved from initial screening through the lifestyle program to follow-up.
The flow may vary depending on the program structure. Abbreviations: CVD, cardiovascular disease; IT/EHR, information technology/electronic health record; WISEWOMAN, Well Integrated Screening and Evaluation for Women Across the Nation.

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Figure 3.
Cost effectiveness of lifestyle programs by intervention: Curves Complete,
Weight Watchers (total), Weight Watchers without fitness, and Weight Watchers with fitness, Vermont WISEWOMAN Program, April 2014–March 2016.

Cost Effectiveness Measure Curves Complete, n = 17 Weight Watchers (Total), n = 39 Weight Watchers Without Fitness, n = 31 Weight Watchers With Fitness, n = 8
Cost per participant completing program, $ 3,445 1,369 1,299 1,648
Cost per participant meeting weight-loss goal, $ 8,613 1,610 1,599 1,648

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.