Is Dietetic Treatment for Undernutrition in Older Individuals in Primary Care Cost-Effective?

ObjectivesUndernutrition 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.DesignA parallel randomized controlled trial.SettingPrimary care.ParticipantsA total of 146 undernourished, independently living older (≥65 years) individuals.InterventionDietetic treatment.MeasurementsMain 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.ResultsThe 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.ConclusionIn this study, dietetic treatment in older, undernourished, community-dwelling individuals was not cost-effective compared with usual care.