What to consider when conducting a cost-effectiveness analysis in a clinical setting.
More data are needed providing strong evidence that nutrition services are cost-effective. Economic evaluations, such as cost-effectiveness analyses, are excellent practice-based research projects. We conducted a cost-effectiveness analysis in a clinical setting to compare the cost-effectiveness of lipid-lowering medications plus diet therapy (medication + diet) with diet therapy alone (diet alone) for treating patients with hypercholesterolemia. Twenty-five adults with hypercholesterolemia (13 receiving medication + diet, 12 receiving diet alone) either participated in an 8-week, home-based, step 1 intervention or were counseled about diet and lifestyle by their care provider. Diet, cost, and laboratory data were collected at baseline, at 9 months, and at 19 months after participation in the intervention (follow-up). Cost per unit change in outcome was evaluated for each group. The diet-alone group made only small changes in dietary intake, changes that were smaller in magnitude than those made by the medication + diet group. Nevertheless, at 9 months, costs per unit change in total serum cholesterol level and low-density lipoprotein cholesterol (LDL-C) level were approximately $24 and $83 less, respectively, for the diet-alone group. At follow-up, however, the cost per unit change in LDL-C level was approximately $17 less for the medication + diet group, which can be explained by the medication + diet group's greater decrease in LDL-C level. The following elements should be considered when conducting a cost-effectiveness analysis of medical nutrition therapy: effectiveness of the nutrition intervention, adequate sample size, confounding variables, compliance with diet and drug therapy, direct and indirect costs of care, and follow-up evaluation.
Naglak
M
M
Department of Health, West Chester University, Pa., USA.
Mitchell
D C
DC
Kris-Etherton
P
P
Harkness
W
W
Pearson
T A
TA
D000328:Adult; D001296:Audiovisual Aids; D002791:Cholesterol, Dietary / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D004032:Diet; D015930:Diet Records; D004035:Diet Therapy / Q000191:economics*; D018752:Diet, Fat-Restricted; D002149:Energy Intake; D006801:Humans; D006937:Hypercholesterolemia / Q000178:diet therapy*; D010349:Patient Compliance; D010353:Patient Education as Topic; D010865:Pilot Projects; D016896:Treatment Outcome
D002791:Cholesterol, Dietary