Cost-Effectiveness of Personalized Nutrition Based on Omic Sciences in Adults With Abdominal Overweight or Obesity: A Within-Trial Analysis and Beyond-Trial Modelling in the United Kingdom and Poland

OBJECTIVES:

Personalized nutrition (PN) interventions can be a way to lower the risk of diet-related diseases and increase healthy life expectancy. This study used results of randomized controlled trials (RCTs) to assess the cost-effectiveness of PN in the United Kingdom (UK) and Poland.

METHODS:

RCTs (with similar study protocols) in both countries compared three interventions: Personalized Plan (PP), Personalized Plan + Behavior (PP+B), and control. Participants received a personalized dietary plan from dieticians in PP and PP+B; PP+B also followed a behavioral change program. Control participants received a non-personalized plan. Study follow-up was four months. Effects were measured in body mass index (BMI), EQ-5D-5L quality of life (QoL), and quality-adjusted life-years (QALYs). Costs (2020 euros) were considered from a societal perspective. Lifetime cost-effectiveness was estimated using a five-state Markov model. Deterministic, probabilistic sensitivity and scenario analyses were performed.

RESULTS:

The RCTs showed no significant differences in BMI and QoL between the interventions, although confidence intervals (CI) showed important uncertainty around the differences (e.g., Poland: PP+B vs Control (BMI:-0.203kg/m2, CI:-0.861,0.456). PN was associated with higher costs than control. When lifetime effectiveness was estimated based on trial data, both PN interventions increased QALYs (vs control) in the UK; in Poland QALYs decreased in PP+B. In the UK, the incremental cost per QALY gain was 16,702 euros for PP vs control and 17,178 euros for PP+B vs control. In Poland, this was 54,604 euros for PP+B vs control; however, control dominated PP. If the maximum expected decrease in BMI within 95%CI was used, control no longer dominated.

CONCLUSIONS:

Based on existing willingness-to-pay thresholds, PP and PP+B would not be cost-effective in Poland; however, this conclusion changes when the maximum expected decrease in BMI is used. In the UK, both PN interventions may be considered cost-effective. Future studies should be larger and/or longer to reduce uncertainty about effectiveness.