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.
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.
J Am Med Dir Assoc. 2014 Mar;15(3):226.e7-226.e13. doi: 10.1016/j.jamda.2013.10.010. Epub 2013 Nov 28.
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.
A parallel randomized controlled trial.
Primary care.
A total of 146 undernourished, independently living older (≥65 years) individuals.
Dietetic treatment.
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.
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.
In this study, dietetic treatment in older, undernourished, community-dwelling individuals was not cost-effective compared with usual care.
老年人营养不良与不良临床结局和高医疗保健成本相关。本研究旨在评估初级保健中饮食治疗与常规护理相比在营养不足的、独立生活的老年（≥65 岁）人群中的成本效益。
平行随机对照试验。
初级保健。
共纳入 146 名营养不足、独立生活的老年人（≥65 岁）。
饮食治疗。
主要结局是与基线相比，体重的变化和 6 个月后的质量调整生命年（QALYs）。从社会角度衡量成本。主要分析按照意向治疗原则进行。采用多重插补法对缺失数据进行插补，采用自举法估计成本差异和增量成本效益比的不确定性。绘制成本效益平面和成本效益接受曲线。
参与者被随机分配接受饮食治疗（n=72）或常规护理（n=74）。6 个月后，饮食治疗组与常规护理组的体重变化（平均差值 0.78kg，95%CI-0.26-1.82）、QALYs（平均差值 0.001，95%CI-0.04-0.04）和总费用（平均差值€1645，95%CI-525-3547）均无统计学差异。QALYs 的增量成本效用比（ICUR）不可解释。体重增加的增量成本效益比（ICER）为 2111。与常规护理相比，饮食治疗的成本效益比为 0.78（体重上限比为€5000），0.06（QALY 上限比为€20000）。
在这项研究中，与常规护理相比，营养不足的、独立生活的老年社区人群的饮食治疗并不具有成本效益。
