Sağlık ve Beslenme Ekonomisi: Diyetisyen ve Maliyet-Yarar Analizi

Beslenme ve sağlık ekonomisi sonuçları arası ilişki birey ve toplum düzeyinde önem taşımaktadır. Günümüzde sağlık bakım hizmetleri yüksek mali sınırlılıklar yaşamakta ve eldeki olanaklarla maksimum olası sağlık yararlarının sağlanabilmesi için politika yapıcılar ile sağlık bakım hizmeti sunanlar büyüyen baskı altındadır. Çalışmalar hastalıkların tedavisi için diyetisyen tarafından verilen yüz yüze tıbbi beslenme tedavisinin klinik etkinlikte, maliyet ve yararında önemli iyileşme sağladığını göstermektedir. Beslenme müdahalelerinin ve tıbbi beslenme tedavisinin maliyet ve yararını değerlendirmek üzere ekonomik çerçevenin oluşturulması gelecekte yürütülecek olan araştırmalarda önemli bir alanı oluşturacaktır. Bu derleme yazıda diyetisyen tarafından verilen tıbbi beslenme tedavisinin maliyet ve yararı, klinik etkinliği özetlenecektir.

Health and Nutrition Economics: Dietitian and Cost-Benefit Analysis

The relationship between nutrition and health economic outcomes is important at both in the individual and the population level. Nowadays, health-care systems are currently facing tremendous budget constraints resulting in growing pressure on decision makers and health-care providers to obtain the maximum possible health benefits of the resources available. Studies show that, face-to-face medical nutrition therapy by a dietitian for the treatment of disease led to significant improvements in clinical effectiveness and cost benefit. Development of an economic framework to evaluate costs and benefits from nutrition interventions and medical nutrition treatments are a potential area for future research. This review summarizes some studies of medical nutrition therapy in which health-related economic and clinical nutrition implications of the intervention by dietitians have been addressed.

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1. Lenoir-Wijnkoop I, Dapoigny M, Dubois D, van Ganse E, Gutiérrez-Ibarluzea I, Hutton J, et al. Nutrition economics – characterising the economic and health impact of nutrition. Br J Nutr. 2011;105:157-66.
2. Marsh K, Phillips CJ, Fordham R, Bertranou E, Hale J. Estimating cost-effectiveness in public health: a summary of modelling and valuation methods. Health Econ Rev. 2012;2(1):17.
3. Briggs ADM, Wolstenholme J, Blakely T, Scarborough P. Choosing an epidemiological model structure for the economic evaluation of non-communicable disease public health interventions. Popul Health Metr. 2016;14(1):17.
4. Naberhuis JK, Hunt VN, Bell JD, Partridge JS, Goates S, Nuijten MJC. Health care costs matter: a review of nutrition economics – is there a role for nutritional support to reduce the cost of medical health care. Nutrition and Dietary Supplements. 2017;9:55–62.
5. Drummond M, Griffin A, Tarricone R. Economic evaluation for devices and drugs – same or different? Value Health. 2009;12:402-4.
6. Freijer K, Lenoir-Wijnkoop I, Russell CA, Koopmanschap MA, Kruizenga HM, Lhachimi SK, et al. Nutrition economics the view of European experts regarding health economics for medical nutrition in disease related malnutrition. European Journal of Clinical Nutrition. 2015;69(5):539-45.
7. Elia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr. 2016;35(2):370–80.
8. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27(1):5-15.
9. Caro JJ, Eddy DM, Kan H, Patel B, Eldessouki R, Briggs AH. Questionnaire to assess relevance and credibility of modeling studies for informing health care decision making: An ISPOR-AMCP-NPC Good Practice Task Force Report. Value Health. 2014;17(2):174–82.
10. Milte RK, Ratcliffe J, Miller MD, Crotty M. Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence. European Journal of Clinical Nutrition. 2013;67(12):1243- 50.
11. Stratton RJ, Green CJ, Elia M. Disease-related malnutrition. An evidence-based approach to treatment. Oxford: CABI International; 2003.
12. Elia M. Nutrition and health economics (Invited Editorial). Nutrition. 2006;22:576-8.
13. Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazaré M, et al. The economic impact of disease-related malnutrition at hospital admission. Clinical Nutrition. 2007;26(6):778-84.
14. Ljungqvist O, de Man F. Under nutrition-a major health problem in Europe. Nutr Hosp. 2009;24:368-70.
15. Ljungqvist O, van Gossum A, Sanz M, de Man F. The European fight against malnutrition. Clin Nutr. 2010;29:149-50.
16. Lammers M, Kok L. Cost-benefit analysis of dietary treatment. SEO Economic Research. Commissioned by the Dutch Association of Dietitians (Nederlandse Vereniging van Diëtisten) Amsterdam. SEO Report No. 2012-76A. November 2012.
17. Avenell A, Brown TJ, McGee MA, Campbell MK, Grant AM, Broom J, et al. What are the long-term benefits of weight reducing diets in adults? A systematic review of randomized controlled trials. J Hum Nutr Dietet. 2004;17:317-35.
18. Avenell A, Broom J, Brown TJ, Poobalan A, Aucott L, Stearns SC, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technology Assessment. 2004;8:21.
19. Dansiger ML, Michael L, Tatsioni A, Wong JB, Chung M, Balk E. Meta-analysis: the effect of dietary counseling for weight loss. Annals of Internal Medicine. 2007;147(1):41- 50.
20. Franz MJ, van Wormer JJ, Crain AL, Boucher JL, Histon R, Caplan W, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. Journal of the American Dietetic Association. 2007;107:1755-67.
21. Brown TJ, Avenell A, Edmunds LD, Moore H, Whittaker V, Avery L, et al. Systematic review of long-term lifestyle interventions to prevent weight gain and morbidity in adults. Obesity Reviews. 2009;10:627-38.
22. Svetkey LP. Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM, et al. Comparison of strategies for sustaining weight loss. The weight loss maintenance randomized controlled trial. JAMA. 2008;299(10):1139-48.
23. Aucott L, Poobalan A, Smith WCS, Avenell A, Jung R, Broom J. Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review. Hypertension. 2005;45:1035-41.
24. Gallardo M, Gascón M, Cruz AJ. Effect of weight loss on metabolic control in people with type 2 diabetes mellitus: a systematic review. Nutr Hosp. 2011;26(6):1242-9.
25. Delahanty LM, Sonnenberg LM, Hayden D, Nathan DM. Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: a controlled trial. J Am Diet Assoc. 2001;101:1012-6.
26. Sikand G, Kashyap ML, Wong ND, Hsu JC. Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidemia and a history of niacin noncompliance. J Am Diet Assoc. 2000;100:218-24.
27. Wolf AM, Conaway MR, Crowther JQ, Hazen KY, Nadler JL, Oneida B, et al. Translating lifestyle intervention to practice in obese patients with type 2 diabetes. Diabetes Care. 2004;27(7):1570-6.
28. Imayama I, Alfano CM, Kong A, Foster-Schubert KE, Bain CE, Xiao L, et al. Dietary weight loss and exercise interventions effects on quality of life in overweight/ obese postmenopausal women: a randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 2011;8:118.
29. NVD (Nederlandse Vereniging van Dietisten), OHDAZ (Overleg Hoofden Dietetiek Academische Ziekenhuizen). The social costs and benefits of dietetics for malnourished patients in hospitalSEO Economic Research, Commissioned by heads of the dietetic departments of the university hospitals (OHDAZ) and Dutch Association of Dietitians (NVD). Amsterdam, The Netherlands, April 2015.
30. Sikand G, Cole RE, Handu D, deWaal D, Christaldi J, Johnson EQ, et al. Clinical and cost benefits of medical nutrition therapy by registered dietitian nutritionists for management of dyslipidemia: A systematic review and meta-analysis. Journal of Clinical Lipidology. 2018;12:1113-22.
31. Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1-full report. J Clin Lipidol. 2015;9(2):129-69.
32. Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris Etherton P, Sikand G, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 2. J Clin Lipidol. 2015;9(Suppl 6):1– 122.
33. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Miller NH, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;129(25 Suppl 2):76-99.
34. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(Suppl 1):120-43.
35. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;129(25 Suppl 2):102-38.