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Cost-effectiveness of medical nutrition therapy by registered dietitians for patients with hypercholesterolemia

      The Massachusetts Dietetic Association (MDA) implemented a state-wide retrospective quality assurance audit to determine the cost-effectiveness of medical nutrition therapy in patients with hypercholesterolemia (>200mg/dL). It is well established that hypercholesterolemia is a significant risk factor for coronary artery disease (CAD). Twenty-three sites across the state collected the data on 285 out-patients seen by a registered dietitian (RD) for a minimum of 2 visits. Patients on lipid lowering medications were excluded from the study. Of the 285 patients, 108 (38%) were male and 177 (62%) were female. The mean age was 51.4 years old (range=22–79). Results showed the average reduction in serum cholesterol was 9.0%, translating to an approximate 18% decrease in risk of CAD.
      The Lipid Research Clinics Program. The lipid research clinics coronary primary prevention trial results: II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 1984;251:365–74.
      1The Lipid Research Clinics Program. The lipid research clinics coronary primary prevention trial results: II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 1984;251:365–74.
      Reduction in serum cholesterol levels correlated with increased time spent with the RD (r=0.188, p<0.001). The average cost per year for nutrition intervention with an RD was $163.00 for a mean of 3.9 visits (median=3.0). Yet an estimated annual cost for patients with hypercholesterolemia on drug therapy is $1450.00. According to the Surgeon General's Report (1988), the cost of treating heart disease in the United States is calculated to be $136 billion. Nutrition therapy should be considered the initial, cost-effective approach in medical management of patients with mild to moderate hypercholesterolemia.
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