Article Text

Download PDFPDF

Cost-effectiveness of habit-based advice for weight control versus usual care in general practice in the Ten Top Tips (10TT) trial: economic evaluation based on a randomised controlled trial
  1. Nishma Patel1,
  2. Rebecca J Beeken2,3,
  3. Baptiste Leurent4,
  4. Rumana Z Omar5,
  5. Irwin Nazareth6,
  6. Stephen Morris1
  1. 1 Department of Applied Health Research, University College London, London, UK
  2. 2 Department of Behavioural Science and Health, University College London, London, UK
  3. 3 Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  4. 4 Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
  5. 5 Department of Statistical Science, University College London, London, UK
  6. 6 Department of Primary Care and Population Health, University College London, London, UK
  1. Correspondence to Nishma Patel; nishma.patel{at}


Objective Ten Top Tips (10TT) is a primary care-led behavioural intervention which aims to help adults reduce and manage their weight by following 10 weight loss tips. The intervention promotes habit formation to encourage long-term behavioural changes. The aim of this study was to estimate the cost-effectiveness of 10TT in general practice from the perspective of the UK National Health Service.

Design An economic evaluation was conducted alongside an individually randomised controlled trial.

Setting 14 general practitioner practices in England.

Participants All patients were aged ≥18 years, with body mass index ≥30 kg/m2. A total of 537 patients were recruited; 270 received the usual care offered by their practices and 267 received the 10TT intervention.

Outcomes measures Health service use and quality-adjusted life years (QALYs) were measured over 2 years. Analysis was conducted in terms of incremental net monetary benefits (NMBs), using non-parametric bootstrapping and multiple imputation.

Results Over a 2-year time horizon, the mean costs and QALYs per patient in the 10TT group were £1889 (95% CI £1522 to £2566) and 1.51 (95% CI 1.44 to 1.58). The mean costs and QALYs for usual care were £1925 (95% CI £1599 to £2251) and 1.51 (95% CI 1.45 to 1.57), respectively. This generated a mean cost difference of −£36 (95% CI −£512 to £441) and a mean QALY difference of 0.001 (95% CI −0.080 to 0.082). The incremental NMB for 10TT versus usual care was £49 (95% CI −£1709 to £1800) at a maximum willingness to pay for a QALY of £20 000. 10TT had a 52% probability of being cost-effective at this threshold.

Conclusions Costs and QALYs for 10TT were not significantly different from usual care and therefore 10TT is as cost-effective as usual care. There was no evidence to recommend nor advice against offering 10TT to obese patients in general practices based on cost-effectiveness considerations.

Trial registration number ISRCTN16347068; Post-results.

  • weight loss programme
  • primary care
  • cost-effectiveness

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from


  • Contributors NP undertook data analysis, interpreted the results, and drafted and wrote the manuscript. RJB helped design the study, undertook data collection and critically reviewed the manuscript. BL helped design the study, and critically reviewed the data and the manuscript. RZO helped design the study and critically reviewed the manuscript. IN helped design the study and critically reviewed the manuscript. SM undertook the data analysis, devised the analysis plan, interpreted the results and critically reviewed the manuscript.

  • Funding This work was funded by the Medical Research Council (MRC) - National Prevention Research Initiative (NPRI) (UK) grant number G080202. RJB’s post was funded through this grant and she is now supported by Yorkshire Cancer Research Academic Fellowship funding. SM, NP and IN are HEFCE-funded. RZO was funded by the National Institute for Health Research.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the funding bodies.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study has been approved by the South East London REC 2, 23/08/2010 (reference number 10/H0802/59). All participants gave informed consent before taking part.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.