Is nutrition care in primary care settings cost effective? A systematic review of trial-based economic evaluations

Background: Effective nutrition care is a fundamental part of high-quality health services. In resource constrained healthcare systems, nutrition interventions must prove they are effective and affordable to be considered by health care funders and policy makers. Aim/Objectives: To synthesise and critique evidence on the cost-effectiveness of nutrition care in primary care settings. Methods: A systematic search of peer-reviewed literature was conducted using Medline, Embase, CINAHL, Cochrane Register, EconLit, and NHS EED from inception to May 2020. For inclusion, studies must have: been a randomised controlled trial; involved a health professional providing nutrition care; been set in a primary care; and reported an incremental cost effectiveness ratio (ICER), which compares the cost of incremental improvements in health outcomes between two options. Findings: Nutrition care was more effective and more costly than usual care in eight of the nine included studies. Nutrition care required increased costs associated with labour and intervention materials. Strategies to reduce costs included using technology to support patients and encouraging nutrition care by all health professionals. Study duration was generally short, and not long enough to adequately capture cost savings from decreased demand for health services. Implications: Nutrition care was implemented as wholly additional to usual care, and as such was more expensive upfront. There is opportunity for primary care to support improved health and wellbeing of communities through nutrition care, however, this requires investment. Future nutrition interventions in primary care should incorporate economic evaluations that use long term timeframes to fully capture the benefit of nutrition care.