Cost-effectiveness of nutritional counseling for obese patients and patients at risk of ischemic heart disease

Int J Technol Assess Health Care. Spring 2005;21(2):194-202.


Objectives: Obesity and dyslipidemia are risk factors for ischemic heart disease, and prevention and treatment in primary care can reduce these risks. The objective of this cost-effectiveness analysis was to compare the costs and effects (in terms of life years gained) of providing nutritional counseling by a general practitioner (GP) or a dietician.

Methods: A total of 60 GPs, who accepted to participate, were randomized either to give nutritional counseling or to refer patients to a dietician for counseling. The life years gained was estimated using a Cox regression model. Costs were estimated on the basis of registered use of time (dieticians) or agreed salaries (GPs).

Results: The effect of nutritional counseling comparing GPs and dieticians is greatest when counseling is performed by a GP--0.0919 years versus 0.0274 years. These effects appear to be moderate, but they are significant. It is also proven that the GP group was the most cost-effective-the cost of gaining 1 extra life year was estimated to be 8213 DKK compared with the dietician group, for which the incremental cost-effectiveness ratio was estimated to be 59,987 DKK.

Conclusions: The effects were moderate, but other studies of other patient groups and interventions report effects within the same magnitude. The GP group was the most cost-effective, but it must be concluded that both counseling strategies were relatively cost-effective. Even though the cost of gaining an extra life year was estimated to be 59,987 DKK in the dietician group, this might be an acceptable price.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Cost-Benefit Analysis*
  • Counseling / economics*
  • Denmark
  • Dietetics / economics*
  • Family Practice / economics*
  • Family Practice / methods
  • Female
  • Humans
  • Male
  • Myocardial Ischemia / prevention & control*
  • Obesity / complications
  • Obesity / diet therapy*
  • Obesity / economics
  • Proportional Hazards Models
  • Quality-Adjusted Life Years
  • Referral and Consultation / economics
  • Technology Assessment, Biomedical
  • Workload