Cost-effectiveness of nutritional counseling for obese patients and patients at risk of ischemic heart disease.
OBJECTIVE
Obesity and dyslipidemia are risk factors for ischemic heart disease, and prevention and treatment in primary care can reduce these risks. The objective of this cost-effectiveness analysis was to compare the costs and effects (in terms of life years gained) of providing nutritional counseling by a general practitioner (GP) or a dietician.


METHODS
A total of 60 GPs, who accepted to participate, were randomized either to give nutritional counseling or to refer patients to a dietician for counseling. The life years gained was estimated using a Cox regression model. Costs were estimated on the basis of registered use of time (dieticians) or agreed salaries (GPs).


RESULTS
The effect of nutritional counseling comparing GPs and dieticians is greatest when counseling is performed by a GP--0.0919 years versus 0.0274 years. These effects appear to be moderate, but they are significant. It is also proven that the GP group was the most cost-effective-the cost of gaining 1 extra life year was estimated to be 8213 DKK compared with the dietician group, for which the incremental cost-effectiveness ratio was estimated to be 59,987 DKK.


CONCLUSIONS
The effects were moderate, but other studies of other patient groups and interventions report effects within the same magnitude. The GP group was the most cost-effective, but it must be concluded that both counseling strategies were relatively cost-effective. Even though the cost of gaining an extra life year was estimated to be 59,987 DKK in the dietician group, this might be an acceptable price.
Olsen
Jens
J
Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Winsløwparken, Denmark. jeo@cast.sdu.dk
Willaing
Ingrid
I
Ladelund
Steen
S
Jørgensen
Torben
T
Gundgaard
Jens
J
Sørensen
Jan
J
D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics*; D003718:Denmark; D004046:Dietetics / Q000191:economics*; D005194:Family Practice / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000517:prevention & control*; D009765:Obesity / Q000150:complications / Q000178:diet therapy* / Q000191:economics; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D012017:Referral and Consultation / Q000191:economics; D013673:Technology Assessment, Biomedical; D016526:Workload