title: Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus.
abstract: OBJECTIVE
  To conduct a cost analysis and cost-effectiveness study based on a randomized clinical trial of basic nutrition care (BC) and practice guidelines nutrition care (PGC) provided by dietitians in outpatient clinics.
  
  
  METHODS
  Subjects with non-insulin-dependent diabetes mellitus (NIDDM) from three states (Minnesota, Florida, Colorado) were randomly assigned to a group receiving BC or a group receiving PGC for a 6-month clinical trial. Along with data about medical and clinical outcomes, data about cost resources were collected. The cost-effectiveness of PGC compared with BC was calculated using per-patient costs and glycemic outcomes for the 6 months of the study. A net cost-effectiveness ratio comparing BC and PGC, including the cost savings resulting from changes in medical therapy, was also calculated.
  
  
  METHODS
  The study reports on a sample of 179 subjects with NIDDM between the ages of 38 and 76 years who completed the clinical trial.
  
  
  RESULTS
  Patients in the PGC group experienced a mean 1.1 +/- 2.8 mmol/L decrease in fasting plasma glucose level 6 months after entry to the study, for a total per-patient cost of $112. PGC costs included one glycated hemoglobin assay used by the dietitian to evaluate nutrition outcomes. Patients in the BC group experienced a mean 0.4 +/- 2.7 mmol/L decrease, for a total per-patient cost of $42. In the PGC group, 17 persons had changes in therapy, which yielded an average 12-month cost savings prorated for all patients of $31.49. In contrast, in the BC group, 9 persons had changes in therapy, for an average 12-month prorated cost savings of $3.13. Each unit of change in fasting plasma glucose level from entry to the 6-month follow-up can be achieved with an investment of $5.75 by implementing BC or of $5.84 by implementing PGC. If net costs are considered (per-patient costs--cost savings due to therapy changes), the cost-effectiveness ratios become $5.32 for BC and $4.20 for PGC, assuming the medical changes in therapy were maintained for 12 months.
  
  
  CONCLUSIONS
  These findings suggest that individualized nutrition interventions can be delivered by experienced dietitians with a reasonable investment of resources. Cost-effectiveness is enhanced when dietitians are engaged in active decision making about intervention alternatives based on the patient's needs.
authors.affiliation: International Diabetes Center, Park Nicollet Medical Foundation, Minneapolis, Minn 55416, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Franz
authors.forename: P L
authors.initials: PL
authors.lastname: Splett
authors.forename: A
authors.initials: A
authors.lastname: Monk
authors.forename: B
authors.initials: B
authors.lastname: Barry
authors.forename: K
authors.initials: K
authors.lastname: McClain
authors.forename: T
authors.initials: T
authors.lastname: Weaver
authors.forename: P
authors.initials: P
authors.lastname: Upham
authors.forename: R
authors.initials: R
authors.lastname: Bergenstal
authors.forename: R S
authors.initials: RS
authors.lastname: Mazze
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy* / Q000191:economics*; D004035:Diet Therapy / Q000191:economics* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose