International Journal of Technology Assessment in Health Care

Research Reports

Development and implementation cost analysis of telephone- and Internet-based interventions for the maintenance of weight loss

Richard T. Meenana1, Victor J. Stevensa1, Kristine Funka1, Alan Baucka1, Gerald J. Jeromea2, Lillian F. Liena3, Lawrence Appela4, Jack F. Hollisa5, Phillip J. Brantleya6 and Laura P. Svetkeya7

a1 Kaiser Permanente Center for Health Research

a2 Towson University

a3 Duke University Medical Center

a4 Johns Hopkins Medical Institutions

a5 Kaiser Permanente Center for Health Research

a6 Louisiana State University

a7 Duke University Medical Center


Objectives: The Weight Loss Maintenance Trial (WLM) was a multicenter, randomized trial comparing two weight loss maintenance interventions, a personal contact (PC) program with primarily telephone-based monthly contacts, and an Internet-based program (interactive technology, IT), to a self-directed control group, among overweight or obese individuals at high cardiovascular risk. This study describes implementation costs of both interventions as well as IT development costs.

Methods: Resources were micro-costed in 2006 dollars from the primary perspective of a sponsoring healthcare system considering adopting an extant intervention, rather than developing its own. Costs were discounted at 3 percent annually. Length of trial participation was 30 months (randomization during February–November 2004). IT development costs were assessed over 36 months. Univariate and multivariate, including probabilistic, sensitivity analyses were performed.

Results: Total discounted IT development costs over 36 months were $839,949 ($2,414 per IT participant). Discounted 30-month implementation costs for 342 PC participants were $537,242 ($1,571 per participant), and for 348 IT participants, were $214,879 ($617 per participant). Under all plausible scenarios, PC implementation costs exceeded IT implementation costs.

Conclusions: Costs of implementing and operating an Internet-based intervention for weight loss maintenance were substantially less than analogous costs of an intervention using standard phone and in-person contacts and are of a magnitude that would be attractive to many health systems, subject to demonstration of cost-effectiveness.


We thank Shane Albright, John Hall, Fran Heinith, Shannon Leitch, and Michael Thornton at the Kaiser Permanente Center for Health Research for important contributions. Grants 5-U01 HL68734, 5-U01 HL68676, 5-U01 HL68790, 5-U01 HL68920, and 5-HL68955 from the National Heart, Lung, and Blood Institute supported this study.