MNT: Cost Effectiveness, Cost-benefit, or Economic Savings of MNT (2009)
MNT Cost-Effectiveness
Health care economics and terminology
Economic analyses, including cost utility, cost effectiveness and cost benefit analyses, evaluate which program or intervention has the greatest effect at the lowest cost. Costs of the intervention are described in monetary terms. Effects or benefits of the intervention can be expressed as either costs (as in cost-benefit analysis) or as health outcomes, such as cases of a disease prevented, years of life gained, quality-adjusted life years (QALYs), or changes in intermediate outcomes (e.g. mg/dL). The variety of ways that cost studies present their outcomes makes it a challenge to compare studies. Economic studies derived from clinical trial data are stronger than model-based analyses, but models can help with economic predicting when trial data are not available. Cost analyses vary by the perspective (i.e., societal, health system) which determines of what type of costs (i.e., direct, indirect, cost to patient) are included in the analysis.
While no standard definition exists for the evaluation of interventions, it has been suggested that interventions which cost less than $20,000 per quality-adjusted life-year (QALY) are appropriate ways to use resources, those that cost $20,000-$100,000 per QALY are probably appropriate, and those that cost more than $100,000 per QALY may not be an appropriate way to use resources. (Urbanski P, Wolf AM, Herman WH. Cost effectiveness issues of diabetes prevention and treatment. Newsflash. 2008;29(1):17-19. Available at http://www.dce.org/links/files/cost_effective.pdf).
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Assessment
What is the evidence to support the cost-effectiveness, cost benefit or economic savings of inpatient MNT services provided by an RD?
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Conclusion
Five studies were reviewed to evaluate the cost-effectiveness, cost benefit, and/or economic savings of inpatient Medical Nutrition Therapy services provided by a Registered Dietitian, involving individualized nutrition assessment and a duration and frequency of care using the Nutrition Care Process. Three studies report that nutrition screening, early assessment and treatment by a Registered Dietitian, leading to early discharge results in cost savings due to reduced length of hospital stay. Two studies demonstrate that appropriate parenteral nutrition use, based on recommendations from a Nutrition Support Team including a Registered Dietitian, results in cost savings. Further research is needed on the cost-effectiveness, cost benefit and/or economic savings of inpatient Medical Nutrition Therapy.
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Grade: II
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
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Evidence Summary: What is the evidence to support the cost-effectiveness, cost benefit or economic savings of inpatient MNT services provided by an RD?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- DeLegge MH, Basel MD, Bannister C, Budak AR. Parenteral nutrition use for adult hospitalized patients: a study of usage in a tertiary medical center. Nutr Clin Pract. 2007; 22: 246-249.
- Kennedy JF, Nightingale J. Cost savings of an adult hospital nutrition support team. Nutrition. 2005; 21: 1,127-1,133.
- Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MAE. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr. 2005; 82: 1,082-1,089.
- Ockenga J, Freudenreich M, Zakonsky R, Norman K, Pirlich M, Lochs H. Nutritional assessment and management in hospitalised patients: implication for DRG-based reimbursement and health care quality. Clinical Nutrition. 2005; 24: 913-919.
- Stern JM, Bruemmer B, Moinpour C, Sullivan KM, Lenssen P, Aker SN. Impact of a randomized, controlled trial of liberal vs. conservative hospital discharge criteria of energy, protein and fluid intake in patients who received marrow transplants. J Am Diet Assoc. 2000; 100: 1,015-1,022.
- Detail
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Search Plan and Results: Cost-Effectiveness of Inpatient MNT 2007
What is the evidence to support the cost-effectiveness, cost benefit or economic savings of lifestyle interventions for diabetes prevention?-
Conclusion
Compared with pharmacotherapy or no intervention, lifestyle interventions for diabetes prevention were cost-effective in terms of cost per quality-adjusted life years gained, based on six cost-effectiveness analyses.
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Grade: I
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
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Evidence Summary: What is the evidence to support the cost-effectiveness, cost benefit or economic savings of lifestyle interventions for diabetes prevention?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- Caro JJ, Getsios D, Caro I, Klittich WS, O'Brien JA. Economic evaluation of therapeutic interventions to prevent type 2 Diabetes in Canada. Diabetic Medicine, 2004; 21 (11): 1,229-1,236.
- Diabetes Prevention Program (DPP) Research Group. Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care 2003; 26: 2,518-2,223.
- Eddy DM, Schlessinger L, Kahn R. Clinical outcomes and cost-effectivenss of strategies for managing people at high risk for diabetes. Ann Intern Med. 2006; 143: 251-264.
- Herman WH, Brandle M, Zhang P, Williamson DF, Matulik MJ, Ratner RE, Lachin JM, Engelgau MM, Diabetes Prevention Program Research Group. Costs associated with the primary prevention of type 2 diabetes mellitus in the Diabetes Prevention Program. Diabetes Care, 2003; 26 (1): 36-47.
- Herman WH, Hoerger TJ, Brandle M, Hicks K, Sorensen S, Zhang P, Hamman RF, Ackermann RT, Engelgau MM, Ratner RE, Diabetes Prevention Program Research Group. The cost-effectivness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005; 142 (5): 323-332.
- Palmer AJ, Roze S, Valentine WJ, Spinas GA, Shaw JE, Zimmet PZ. Intensive lifestyle changes or metformin in patients with impaired glucose tolerance: Modeling the long-term health economic implications of the diabetes prevention program in Australia, France, Germany, Switzerland, and the United Kingdom. Clin Ther. 2004; 26: 304-321.
- Detail
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Search Plan and Results: Cost-Effectiveness of Diabetes Prevention 2007
What is the evidence to support the cost-effectiveness, cost benefit or economic savings of outpatient MNT services provided by an RD?-
Conclusion
Ten studies were reviewed to evaluate the cost-effectiveness, cost benefit and economic savings of outpatient Medical Nutrition Therapy (MNT), involving in-depth individualized nutrition assessment and a duration and frequency of care using the Nutrition Care Process to manage disease. Using a variety of cost-effectiveness analyses, the studies affirm that MNT resulted in improved clinical outcomes and reduced costs related to physician time, medication use and/or hospital admissions for people with obesity, diabetes and disorders of lipid metabolism, as well as other chronic diseases. Further research is needed on the cost-effectiveness, cost benefit and economic savings of outpatient MNT in other disease states.
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Grade: I
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
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Evidence Summary: What is the evidence to support the cost-effectiveness, cost benefit or economic savings of outpatient MNT services provided by an RD?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- Johannesson M, Fagerberg B. A health-economic comparison of diet and drug treatment in obese men with mild hypertension. J Hypertension. 1992; 10: 1063-1070.
- McGehee MM, Johnson EQ, Rasmussen HM, Sahyoun N, Lynch MM, Carey M. Benefits and costs of medical nutrition therapy by registered dietitians for patients with hypercholesterolemia. J Am Diet Assoc. 1995; 95: 1041-1043.
- Pritchard DA, Hyndman J, Taba F. Nutritional counselling in general practice: A cost effective analysis. J Epidemiol Community Health. 1999; 53: 311-316.
- Sheils JF, Rubin R, Stapleton DC. The estimated costs and savings of medical nutrition therapy: the Medicare population. J Am Diet Assoc. 1999; 99: 428-435.
- Sikand G, Kashyap ML, Wong ND, Hsu JC. Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidemia and a history of niacin noncompliance. J Am Diet Assoc. 2000; 100: 218-224.
- Sikand G, Kashyap ML, Yang I. Medical nutrition therapy lowers serum cholesterol and saves medication costs in men with hypercholesterolemia. J Am Diet Assoc. 1998; 98: 889-894.
- Wolf AM, Siadaty M, Yaeger B, Conaway MR, Crowther JQ, Nadler JL, Bovbjerg VE. Effects of lifestyle intervention on health care costs: Improving Control with Activity and Nutrition (ICAN). J Am Diet Assoc. 2007; 107: 1365-1373.
- Detail
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Search Plan and Results: Cost-Effectiveness of Outpatient MNT 2007
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Conclusion