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F I N A L R E P O R T


Understanding the value of Impromy

A research impact assessment for the Health & Biosecurity Business Unit of the CSIRO


Prepared for The CSIRO

October 2017


THE CENTRE FOR INTERNATIONAL ECONOMICS

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Contents


Abstract 4

  1. An overview of Impromy 5

    Our understanding of Impromy 6

    Adoption to date 8

  2. Expected outcomes and impacts 9

    Weight loss outcomes to date 9

    Drivers of economic value of Impromy 10

  3. High level estimates of value from Impromy 15

BOXES, CHARTS AND TABLES

    1. New member activity for Impromy 8

    2. Age distribution of members 8

    1. Average annual healthcare cost of diabetes per person 13

    2. Impact on diabetes complications of reducing HbA1c by 1 per cent 14

3.1 Estimating the avoided health care costs due to Impromy 16


Abstract



1 An overview of Impromy


‘Impromy’ is a multi-strategy approach to addressing the problem of obesity and overweight in Australia. It is delivered via a partnership between the CSIRO and Probiotec, with CSIRO being instrumental to its substantiation, uptake, consumer retention, and improved program design.

The prevalence of overweight and obesity among Australians has been steadily increasing for the past 30 years. In 2011–12, around 60 per cent of Australian adults were classified as overweight or obese, and more than 25 per cent of these fell into the obese category.1

Health problems related to excess weight impose substantial economic burdens on individuals, families and communities. Data from the Australian Diabetes, Obesity and Lifestyle (AusDiab) study indicate that the total direct cost for overweight and obesity in 2005 was $21 billion ($6.5 billion for overweight and $14.5 billion for obesity). The same study estimated indirect costs of $35.6 billion per year, resulting in an overall total annual cost of $56.6 billion.2

Weight management strategies generally focus on energy restriction and/or altering macronutrient profiles (low fat/carbohydrate or high protein/fat diets). However, these are prone to challenges with ongoing compliance, which is known to prevent meaningful weight loss over the medium to longer term for certain individuals.3

The use of additional strategies to improve compliance and guide individual choices can improve the sustainability of weight loss outcomes. Keogh et al found that the use of meal replacements over 3 months led to greater reductions in body mass in type 2 diabetics than the use of only a commercially available diet book in a community setting.4

‘Impromy’ is an attempt to take a multi-strategy approach to achieving the sustainability of weight loss goals. It combines the CSIRO Total Wellbeing Diet Book with commercial meal replacement, in-pharmacy and online support to maximise user interaction.


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  1. ABS (2012) Australian health survey: First results, 2011–12. ABS cat. no. 4364.0.55.001. Canberra: Australian Bureau of Statistics.

  2. Colagiuri S, Lee CMY, Colagiuri R et al. (2010) The cost of overweight and obesity in Australia. Med J Aust 192: 260–64.

  3. Naude, C. E., et al., ‘Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systemic review and meta-analysis’, PloS one, 2014, 9(7): p. e100652.

  4. Keogh, J. B and Clifton, P. M., ‘Meal replacements for weight loss in type 2 diabetes in a community setting’, Journal of Nutrition and metabolism, 2012.


    Our understanding of Impromy

    Impromy is delivered via a commercial partnership between CSIRO and Probiotec called the Impromy Health and Weight Management Program, and was developed collaboratively between the two parties.

    Impromy is offered through pharmacies, and provides a package of meal replacements or ‘shakes’ (for breakfast and lunch), high protein meals and ongoing support by trained pharmacy staff.


    The role of the CSIRO

    The CSIRO has been important to the early stage development of Impromy, and continues to be involved in shoring up consumer adoption, consumer retention, and improving program design.

    For instance, CSIROs role has included:

  5. The CSIRO, undated. Meal replacement programs — Evolution to new evidence. Presentation by Manny Noakes, Program Director of Nutrition and Health at the CSIRO.

  6. Ibid.

  7. Brindal E, Wittert G. (2016) The weight balancing act and allostasis: Commentary on the homeostasis theory of obesity. Health Psychology Open

  8. The LOOK AHEAD trial examined over 5000 overweight/obese adults with type 2 diabetes randomised to usual care or an intensive lifestyle intervention that included use of meal replacements.

  9. Wadden T.A., West D.S., Neiberg R.H., Wing R.R., Ryan D.H., Johnson K.C., Foreyt J.P., Hill J.O., Trence D.L., Vitolins M.Z. One-year weight losses in the Look AHEAD study: Factors associated with success. Obesity. 2009;17:713–722. doi: 10.1038/oby.2008.637.

  10. Griffith University, 2015. Leveraging online and in-pharmacy support to enhance weight loss: a population based analysis. By Professor Lauren Williams and Professor Allan Cripps. April 2015.


Adoption to date

Since its inception, 45 998 members have joined the Impromy Classic (In-Store Consultation) Program.

The profile of new member acquisitions and in-store consultations is set out in table 1.1, which shows a steady upward movement in the average number of in-store consultations per new member.

Forty–eight per cent of members that choose to report their age are between 41 and 60 years of age (table 1.2).

Most members that report their gender are female (85 per cent).


    1. New member activity for Impromy


      2014

      2015

      2016

      2017a

      New members

      12 157

      13 966

      12 217

      7 636

      In-store consultations

      49 083

      124 126

      120 156

      82 060

      Average consultations per new member

      4.04

      8.89

      9.84

      10.75

      a Year to date to the end of July 2017. Pro-rated to December 2017, total new members would be 13 146, and total instore consultations would be 141 282.

      Note New member data excludes members that ‘re-start’ their program, and excludes members who have joined the Flexi Program or used the Metabolic C12 product.

      Source: CSIRO, unpublished.


    2. Age distribution of members


Age profile

16-20

21-31

31-40

41-50

51-60

61-70

71-80

81+

No. of members

564

2757

4312

6512

6984

4930

1845

311

Per cent of total

2.0

9.8

15.3

23.1

24.8

17.5

6.5

1.1

Note: Includes only those members that declare their age, which is 61 per cent of all members. Source: CSIRO, unpublished.


2 Expected outcomes and impacts


While the results are preliminary and early, consumers of Impromy are understood to be realising weight loss of 4.5 to 6.6 kilos.

Given that most customers of Impromy have health risk factors outside the healthy range, achieving weigh loss for this group should be expected to reduce disease risk and the burden of disease associated with overweight and obesity.


Weight loss outcomes to date

Impromy has been in place for nearly three years, with early reported results including:

However, there will still be a strong component of individual-level commitment, which will only partly be influenced by CSIRO’s involvement. There are also likely to be outcomes that are more properly attributed to Probiotec and/or individual pharmacies rather than CSIRO.

For instance, the pharmacy visit interval appears to correlate with weight loss at 12 weeks, with weight loss averaging 8.9 kilogram for those visiting their pharmacy weekly, compared to 2.7 kilograms, if visits are more than 3 weeks apart. This may be owing to additional engagement by the individual, and/or the value of the interaction with the pharmacy support, as well as the cohort (for instance, they might have had a higher starting weight).

Aside from confirming a positive association between CSIRO and expected health outcomes associated with Impromy, this review is unable to estimate the attributable proportion of value for the CSIRO or any other input.


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  1. CSIRO reviewed member data and found that members who visited the pharmacy weekly (at that stage we recommended fortnightly visits) for an Impromy consult, were achieving substantially better results than those visiting fortnightly and monthly.

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18 Understanding the value of Impromy


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