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Health Economics of Primary Care Nutrition Interventions: a Systematic Review and Meta-Analysis
Clara Wosser1, Kyriaki Apergi2, Sharleen O'Reilly1
1School of Agriculture and Food Science, University College Dublin, Belfield, D04 V1W8, Ireland.
Context:
Non communicable diseases (NCDs) impose a major global health and economic burden, with poor diet recognized as a leading modifiable risk factor. Nutrition interventions delivered by qualified professionals in primary care settings are recommended for prevention and management of NCDs, yet their economic value remains uncertain.
Objective:
We sought to systematically review and synthesize evidence on the cost-effectiveness of nutrition care interventions delivered by nutrition professionals in primary care, from both societal and health care system perspectives.
Data Sources:
A comprehensive search of 6 databases (Ovid Medline, PubMed, Embase, CINAHL, Cochrane CENTRAL, EconLit) was conducted up to October 2024 following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (Supporting Materials). The protocol was registered in PROSPERO under the number: CRD420251029435.
Data Extraction:
Randomized controlled trials reporting economic evaluations of primary care nutrition interventions were eligible. Two reviewers independently screened studies and extracted data on intervention characteristics, cost perspective, incremental costs, incremental effects, and quality-adjusted life years. Risk of bias was assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) checklist.
Data Analysis:
The incremental net benefit (INB) was calculated using harmonized cost and effect data. The meta-analysis employed random-effects models stratified by perspective. Sensitivity analyses excluded influential outliers. Subgroup analyses explored variations by delivery mode, target condition, and study quality.
Conclusions:
Among 25 included studies, 56% were cost-effective and 20% were moderately cost-effective. Pooled INB favored cost-effectiveness from a societal perspective (€650.32), while the health care system perspective indicated initial investment requirements (-€402.65). Telehealth delivery and diabetes-focused interventions demonstrated the strongest economic outcomes. Despite high heterogeneity, sensitivity analyses improved pooled estimates, reinforcing the robustness of findings. Nutrition interventions in primary care represent a strategic opportunity to improve health outcomes and optimize resource allocation, particularly when integrated into telehealth models and multidisciplinary care frameworks.
Systematic Review Registration:
PROSPERO registration No. [CRD420251029435].
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