A Cost-Effectiveness Study of Diet Counseling.

Abstract

Four modes of diet counseling as practiced by three health care practitioners were evaluated for four effectiveness variables and the costs of treatment. Group counseling within a behavior modification framework led by a dietitian and individual counseling by a dietitian, dietetic technician, and a nurse comprised the treatment modes. The population counseled consisted of 157 patients with maturity onset diabetes belonging to an urban HMO. Measures of the percent overweight lost, decrease in plasma glucose, the number of disability days, and the presence or absence of glycosuria were the effectiveness variables used. Practitioner salary and patient materials and other expendable supplies were the cost factors employed in the analysis. The content of each of the treatment protocols was analyzed by observational methods. The significance of the mean differences in the effectiveness variables at the beginning and end of a six-month period was analyzed using one-way analysis of variance and the Newman-Keuls procedure. The most effective treatment was group counseling by the dietitian. This was followed by individual counseling by the dietitian, dietetic technician, and nurse in descending order of effectiveness. The least expensive treatment was counseling by the dietetic technician; the most expensive was individual counseling by the dietitian. When economic constraints must dictate program decision, counseling by the technician appears to be the treatment of choice. Under less stringent economic circumstances where effectiveness is a priority, group sessions with a behavioral orientation conducted by the dietitian offer the most effective counseling at one-third more cost. This study clearly highlights the cost-effectiveness of nutrition intervention by the non-physician members of the health care team.