title: Is dietetic treatment for undernutrition in older individuals in primary care cost-effective?
abstract: OBJECTIVE
  Undernutrition in older age is associated with adverse clinical outcomes and high health care costs. This study aimed to evaluate the cost-effectiveness of a dietetic treatment in primary care compared with usual care in older, undernourished, community-dwelling individuals.
  
  
  METHODS
  A parallel randomized controlled trial.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  A total of 146 undernourished, independently living older (≥65 years) individuals.
  
  
  METHODS
  Dietetic treatment.
  
  
  METHODS
  Main outcomes were change in kilogram body weight compared with baseline and quality-adjusted life years (QALYs) after 6 months. Costs were measured from a societal perspective. The main analysis was performed according to the intention-to-treat principle. Multiple imputation was used to impute missing data and bootstrapping was used to estimate uncertainty surrounding cost differences and incremental cost-effectiveness ratios. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated.
  
  
  RESULTS
  The participants were randomized to receive either dietetic treatment (n = 72) or usual care (n = 74). After 6 months, no statistically significant differences were found between the dietetic treatment and usual care group in body weight change (mean difference 0.78 kg, 95% CI -0.26-1.82), QALYs (mean difference 0.001, 95% CI -0.04-0.04) and total costs (mean difference €1645, 95% CI -525-3547). The incremental cost-utility ratio (ICUR) for QALYs was not interpretable. The incremental cost-effectiveness ratio (ICER) for body weight gain was 2111. The probability that dietetic treatment is cost-effective compared with usual care was 0.78 for a ceiling ratio of €5000 for body weight and 0.06 for a ceiling ratio of €20.000 for QALY.
  
  
  CONCLUSIONS
  In this study, dietetic treatment in older, undernourished, community-dwelling individuals was not cost-effective compared with usual care.
authors.affiliation: Department of Health Sciences and EMGO Institute for Health and Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands; Dutch Malnutrition Steering Group, Amsterdam, The Netherlands. Electronic address: jannekeschilp@hotmail.com.
authors.forename: Janneke
authors.initials: J
authors.lastname: Schilp
authors.affiliation: Department of Health Sciences and EMGO Institute for Health and Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands; Department of Health Economics & Health Technology Assessment, Department of Health Sciences and EMGO Institute for Health and Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Bosmans
authors.affiliation: Department of Health Sciences and EMGO Institute for Health and Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands; Dutch Malnutrition Steering Group, Amsterdam, The Netherlands; Departments of Nutrition and Dietetics, Internal Medicine, and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hinke M
authors.initials: HM
authors.lastname: Kruizenga
authors.affiliation: Department of Health Sciences and EMGO Institute for Health and Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: Hanneke A H
authors.initials: HAH
authors.lastname: Wijnhoven
authors.affiliation: Department of Health Sciences and EMGO Institute for Health and Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Visser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D004035:Diet Therapy / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000191:economics; D009426:Netherlands; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years
keywords: Undernutrition; cost-effectiveness; dietetic treatment; primary care