Obesity Program Cost-Effectiveness Modeled in Southern Italy

Researchers from the National Institute of Gastroenterology S. de Bellis Research Hospital in Bari, Italy, published a model-based simulation study assessing the cost-effectiveness of a publicly funded lifestyle intervention for adults with obesity in Southern Italy. The study, appearing in Frontiers in Public Health, utilized a deterministic cohort state-transition model to evaluate the economic and health outcomes of a program combining supervised exercise and nutritional counselling. The primary objective was to determine whether such an intervention could be considered cost-effective from both societal and payer perspectives, while also estimating its potential impact on the burden of colorectal and hepatocellular cancer.

The simulation employed a Python-based state-transition cohort model with a 20-year time horizon, simulating 19,000 treatment episodes. The target population consisted of individuals with a body mass index between 30.0 and 34.9 kg/m², a range classified as obesity. The model compared the integrated lifestyle programme against standard unstructured care, analyzing costs in constant 2024 euros and quality-adjusted life years (QALYs). Both costs and QALYs were discounted at the same real rate.

In the standard scenario, the intervention yielded 1,354.50 incremental QALYs, equating to 0.071 QALYs per participant. The net societal cost of the programme was estimated at €30.06 million. The incremental cost-effectiveness ratio (ICER) was calculated at €22,192 per QALY gained from a societal perspective, and €25,987 per QALY from a payer perspective. Using a willingness-to-pay threshold of €30,000 per QALY, the model estimated a net monetary benefit of €10.58 million, indicating that the programme generated value for money under these specific assumptions.

Probabilistic sensitivity analysis, conducted over 10,000 iterations, indicated that the intervention was cost-effective in 67.7% of the simulated draws. The study also included a worst-case stress test that compounded reduced efficacy, higher relapse rates, shorter benefit duration, and a higher 6% discount rate. Under these extreme conditions, the ICER rose sharply to €183,641 per QALY, and the net monetary benefit turned negative to −€30.56 million, with the probability of cost-effectiveness falling below 0.1%.

A key component of the model involved a temporal-convolution module with a 3-year oncological latency period to estimate cancer cases avoided. The researchers assumed that sustained weight loss would reduce 50% of the excess cancer risk associated with obesity. Under this assumption, the model projected a 1.44% relative reduction in the incidence of colorectal and hepatocellular cancer. This translated to 7.2 cases avoided, with a 95% central range of 2.1 to 16.3 cases. The associated cost offsets from avoided cancer care were estimated at €123,000.

Subject of Research: Cost-effectiveness of an integrated lifestyle intervention for obesity in southern Italy: a model-based simulation of costs, health outcomes and gastrointestinal cancer burden

Article Title: Cost-effectiveness of an integrated lifestyle intervention for obesity in southern Italy: a model-based simulation of costs, health outcomes and gastrointestinal cancer burden

Article References: Polignano, M., Guido, D., Rotolo, O., Bianco, A., Dalfino, G., Armenise, M., & Giannelli, G. (2026). Cost-effectiveness of an integrated lifestyle intervention for obesity in southern Italy: a model-based simulation of costs, health outcomes and gastrointestinal cancer burden. Frontiers in Public Health, 14, Article 1956296. https://doi.org/10.3389/fpubh.2026.1956296

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1956296

Keywords: Cost-effectiveness, integrated, lifestyle, intervention, obesity, southern, Italy, model-based, simulation, costs, health, outcomes