Franz M J, Splett P L, Monk A, Barry B, McClain K, Weaver T, Upham P, Bergenstal R, Mazze R S
International Diabetes Center, Park Nicollet Medical Foundation, Minneapolis, Minn 55416, USA.
J Am Diet Assoc. 1995 Sep;95(9):1018-24. doi: 10.1016/S0002-8223(95)00277-4.
To conduct a cost analysis and cost-effectiveness study based on a randomized clinical trial of basic nutrition care (BC) and practice guidelines nutrition care (PGC) provided by dietitians in outpatient clinics.
Subjects with non-insulin-dependent diabetes mellitus (NIDDM) from three states (Minnesota, Florida, Colorado) were randomly assigned to a group receiving BC or a group receiving PGC for a 6-month clinical trial. Along with data about medical and clinical outcomes, data about cost resources were collected. The cost-effectiveness of PGC compared with BC was calculated using per-patient costs and glycemic outcomes for the 6 months of the study. A net cost-effectiveness ratio comparing BC and PGC, including the cost savings resulting from changes in medical therapy, was also calculated.
The study reports on a sample of 179 subjects with NIDDM between the ages of 38 and 76 years who completed the clinical trial.
Patients in the PGC group experienced a mean 1.1 +/- 2.8 mmol/L decrease in fasting plasma glucose level 6 months after entry to the study, for a total per-patient 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 therapy, which yielded an average 12-month cost savings prorated for all patients 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. Each unit of change in fasting plasma glucose level from entry to the 6-month follow-up can be achieved with an investment of $5.75 by implementing BC or of $5.84 by implementing PGC. If net costs are considered (per-patient costs--cost savings due to therapy changes), the cost-effectiveness ratios become $5.32 for BC and $4.20 for PGC, assuming the medical changes in therapy were maintained for 12 months.
These findings suggest that individualized nutrition interventions can be delivered by experienced dietitians with a reasonable investment of resources. Cost-effectiveness is enhanced when dietitians are engaged in active decision making about intervention alternatives based on the patient's needs.
基于一项随机临床试验，对门诊营养师提供的基础营养护理（BC）和实践指南营养护理（PGC）进行成本分析和成本效益研究。
来自三个州（明尼苏达州、佛罗里达州、科罗拉多州）的非胰岛素依赖型糖尿病（NIDDM）患者被随机分配到接受BC组或接受PGC组，进行为期6个月的临床试验。除了收集有关医疗和临床结果的数据外，还收集了有关成本资源的数据。使用每位患者的成本和研究6个月期间的血糖结果，计算PGC与BC相比的成本效益。还计算了比较BC和PGC的净成本效益比，包括因药物治疗变化而节省的成本。
该研究报告了179名年龄在38至76岁之间完成临床试验的NIDDM患者样本。
进入研究6个月后，PGC组患者的空腹血糖水平平均下降1.1±2.8 mmol/L，每位患者的总成本为112美元。PGC成本包括营养师用于评估营养结果的一次糖化血红蛋白检测。BC组患者的空腹血糖水平平均下降0.4±2.7 mmol/L，每位患者的总成本为42美元。在PGC组中，17人有治疗方案的改变，这使得所有患者按比例计算的平均12个月成本节省为31.49美元。相比之下，在BC组中，9人有治疗方案的改变，按比例计算的平均12个月成本节省为3.13美元。从进入研究到6个月随访期间，空腹血糖水平每变化一个单位，实施BC的投资为5.75美元，实施PGC的投资为5.84美元。如果考虑净成本（每位患者的成本——因治疗变化而节省的成本），假设药物治疗的变化持续12个月，那么BC的成本效益比为5.32，PGC的成本效益比为4.20。
这些研究结果表明，经验丰富的营养师可以通过合理的资源投入提供个性化营养干预。当营养师根据患者需求对干预方案进行积极决策时，成本效益会得到提高。
