Mirey Karavetian, Rana Rizk, Mickael Hiligsmann and Silvia Evers
Zayed University, UAE
Maastricht University, The Netherlands
Posters & Accepted Abstracts: J Nephrol Ther
We assessed the cost-effectiveness of nutrition education by dedicated dietitians (DD) for hyperphosphatemia management among hemodialysis patients. 545 prevalent patients were allocated to DD, trained hospital dietitian (THD) and existing practice (EP) groups. During Phase I (6 months), DD (n=116) received intensive education by DD trained on renal nutrition; THD (n=299) received usual care from trained hospital dietitians; EP (n=130) received usual care from untrained hospital dietitians. Patients were followed-up during Phase II (6 months). At baseline, EP had the lowest weekly hemodialysis time and DD had the highest mean serum phosphorus and malnutrition-inflammation score. The additional costs of the intervention were low compared with the societal costs (DD:$76.7,$21,007.7; EP:$4.6,$18,675.4; THD:$17.4,$20,078.6, respectively). Between Phases I and II, DD showed the greatest decline in services use and highest mean decrease in costs (DD:-$2,364.0; EP:-$1,727.7; THD:-$1,105.7). At endline, DD experienced the greatest mean decrease in adjusted serum phosphorus (DD:-0.32; EP:+0.16; THD:+0.04 mg/dL), no difference in quality-adjusted-life-years (QALY), and highest costs. DD protocol had a cost-effectiveness ratio of $7,853.6/mg decrease in phosphorus, compared with EP; and was dominated by THD. Regarding QALY, DD was dominated by EP and THD. The results were sensitive to changes in key outcomes. DD yielded the greatest effectiveness and decrease in costs, but did not affect QALY. Regarding serum phosphorus, DD was likely to be cost-effective compared with EP but had a low probability of being cost-effective compared with THD. Regarding QALY, DD was not likely to be cost-effective. Assessing DD├ó┬?┬?s long-term cost-effectiveness, on similar groups, is recommended.
Mirey Karavetian earned her PhD in Health Promotion from Maastricht University, the Netherlands and her Dietetics degree from American University of Beirut, Lebanon. She has extensive experience in nutrition management of the chronically and critically ill patients. She shares her experience in conferences and workshops locally and regionally in the aim of training health care professionals for better health care. She also is trained and specialized in health care quality (setting policies and procedures and training staff on the new set of rules in health care settings). Her research is focused on identifying effective strategies to change dietary behavior in chronically ill patients. Her publications focus on dietary management of hemodialysis patients and finding the optimal dietitian-to-patient ratio needed in the hemodialysis unit in the Arab world for optimal clinical outcomes. She has shared her experience in national and international conferences. She currently is an Assistant Professor in the Department of Natural Sciences in Public Health, College of Sustainable Sciences and Humanities, Zayed University, Dubai.