Cost-effectiveness of Medical Nutrition Therapy in the Treatment of Hypercholesterolemia.

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The National Cholesterol Education Program (NCEP) identified diet therapy as the first line of treatment for hypercholesterolemia. NCEP guidelines suggest that a physician (MD) and other health professionals implement the Step 1 diet and that a registered dietitian (RD) implement Step 2 diet therapy. To evaluate the cost-effectiveness of this approach, we randomly assigned 90 patients (60 males, 30 females) aged 21-65 with chol > 200 mg/dl and not on hypolipidemic drugs to receive either medical nutrition therapy (MNT) from RDs or usual care (UC) from MDs. MNT included a NCEP based cholesterol lowering protocol which required 2-6 visits over 6 months, depending on lipid results. During the 6 month intervention period, MDs and patients agreed not to use lipid lowering drugs. Results at 3 and 6 months were compared between treatment groups using analysis of covariance controlling for baseline and gender. Baseline 3month 6month Chol MNT 238 (28) 222 (27)+ 222 (23)* (mg/dL) UC 237 (29) 238 (27) 232 (25) LDL MNT 165 (23) 154 (24)* 153 (21) (mg/dL) UC 163 (26) 162 (26) 159 (23) Mean (SD) *P < 0.05 + P< 0.01 Patients who received MNT had a 6% decrease in cholesterol and LDL levels compared with no change in UC subjects. Furthermore, 82% of MNT vs 43% of UC patients showed cholesterol lowering (31% of MNT vs 11% of UC patients showed ⩾ 11% decrease in cholesterol levels). In the first 3 months, MDs spent 1-2 minutes per patient discussing cholesterol levels in both treatment groups whereas RDs spent 90 minutes per patient providing MNT. The additional cost of MNT was $217 per patient, for an average of 2.5 visits per patient. The cost effectiveness ratio for MNT was $36 per 1% decrease in cholesterol and LDL level. This study suggests that MNT is cost-effective and produces significantly better lipid outcomes than customary cholesterol lowering advice.