TY - JOUR
T1 - Is Dietetic Treatment for Undernutrition in Older Individuals in Primary Care Cost-Effective?
AU - Schilp, J.
AU - Bosmans, J.E.
AU - Kruizenga, H.M.
AU - Wijnhoven, H.A.H.
AU - Visser, M.
PY - 2014
Y1 - 2014
N2 - Objectives: 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. Design: A parallel randomized controlled trial. Setting: Primary care. Participants: A total of 146 undernourished, independently living older (≥65 years) individuals. Intervention: Dietetic treatment. Measurements: 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. Conclusion: In this study, dietetic treatment in older, undernourished, community-dwelling individuals was not cost-effective compared with usual care. © 2014 American Medical Directors Association, Inc.
AB - Objectives: 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. Design: A parallel randomized controlled trial. Setting: Primary care. Participants: A total of 146 undernourished, independently living older (≥65 years) individuals. Intervention: Dietetic treatment. Measurements: 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. Conclusion: In this study, dietetic treatment in older, undernourished, community-dwelling individuals was not cost-effective compared with usual care. © 2014 American Medical Directors Association, Inc.
U2 - https://doi.org/10.1016/j.jamda.2013.10.010
DO - https://doi.org/10.1016/j.jamda.2013.10.010
M3 - Article
C2 - 24290909
SN - 1525-8610
VL - 15
SP - 226.e7-226.e13
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 3
ER -