Evaluation of Cost-Effectiveness of Medical Nutrition Therapy: Meta-Analysis

Kim, Hyun Ah; Yang, Il Sun; Lee, Hae Young; Lee, Young Eun; Park, Eun Cheol; Nam, Chung Mo

Abstract

OBJECTIVES
A meta-analysis of the literatures was conducted to evaluate the cost-effectiveness of medical nutrition therapy by dietitians.
METHODS
The 30 studies were identified from a computerized search of published research on MEDLINE, Science-Direct and the PQD database until May, 2002 and a review of reference lists. The main search terms were "dietitian", "dietary intervention", "nutrition intervention", "cost", "cost-effectiveness" and "cost-benefit analysis". The subgroup analysis was performed by publication year, study design, intervention provider, type of patient (in/out-patient) and type of cost (total cost/direct cost). Two reviewers independently selected trials for inclusion, assessed the quality and extracted the data.
RESULTS
The 30 studies were identified using the electric database search and bibliographies. The 17 trials were eligible for inclusion criteria, then the systematic review and a meta-analysis were conducted on effectiveness and cost-effectiveness of medical nutrition therapy. The quality of the studies was evaluated using the quality assessment tool for observational studies. The quality score was 0.515+/-0.121 (range : 0.279-0.711, median : 0.466). The meta-analysis of 17 studies based on the random effect model showed that medical nutrition therapy was highly effective in treating the diseases (effect size 0.3092 : 95% confidence interval 0.2282-0.3303). The vote-counting method, one of meta-analysis methods, was applied to evaluate the cost-effectiveness of medical nutrition therapy conducted by dietitians. Two criteria (method 1, method 2) for voting were used. The calculated p-values for method 1 (more conservative method) and method 2 (less conservative method) were 0.1250 and 0.0106, respectively. Medical nutrition therapy by dietitians was significantly cost-effective in the method 2.
CONCLUSION
This meta-analysis showed that the effectiveness of medical nutrition therapy was statistically significant in treating disease (effect size 0.3092), and that the cost-effectiveness of medical nutrition therapy was statistically significant in the method 2 (less conservative method) of vote counting.