COST-EFFECTIVENESS OF MEDICAL NUTRITION THERAPY PROVIDED BY DIETITIANS FOR PERSONS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Objective To conduct a cost analysis and cost-effectiveness study base d on a randomized clinical trial of basic nutrition care (BC) and prac tice guidelines nutrition care (PGC) provided by dietitians in outpati ent clinics. Design Subjects with non-insulin-dependent diabetes melli tus (NIDDM) from three states (Minnesota, Florida, Colorado) were rand omly assigned to a group receiving BC or a group receiving PGC for a 6 -month clinical trial. Along with data about medical and clinical outc omes, data about cost resources were collected. The cost-effectiveness of PGC compared with BC was calculated using per-patient costs and gl ycemic outcomes for the 6 months of the study. A net cost effectivenes s ratio comparing BC and PGC, including the cost savings resulting fro m changes in medical therapy, was also calculated. Subjects The study reports on a sample of 119 subjects with NIDDM between the ages of 38 and 16 years who completed the clinical trial. Results Patients in the PGC group experienced a mean 1.1+/-2.8 mmol/L decrease in fasting pla sma glucose level 6 months after entry to the study, for a total per-p atient 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 ther apy, which yielded an average 12-month cost savings prorated for all p atients 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. E ach unit of change in fasting plasma glucose level from entry to the g -month follow-up can be achieved with an investment of $5.75 by implem enting BC or of $5.84 by implementing PGC. If net costs are considered (per-patient costs - cost savings due to therapy changes), the cost-e ffectiveness ratios become $5.32 for BC and $4.20 for PGC, assuming th e medical changes in therapy were maintained for 12 months. Applicatio ns These findings suggest that individualized nutrition interventions can be delivered by experienced dietitians with a reasonable investmen t of resources. Cost-effectiveness is enhanced when dietitians are eng aged in active decision making about intertrention alternatives based on the patient's needs.