Departments of Nutrition and Dietetics, Internal Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Clin Nutr. 2012 Apr;31(2):183-90. doi: 10.1016/j.clnu.2011.10.009. Epub 2011 Nov 8.
BACKGROUND & AIMS: Older people are vulnerable to malnutrition which leads to increased health care costs. The aim of this study was to evaluate the cost-effectiveness of nutritional supplementation from a societal perspective.
This randomized controlled trial included hospital admitted malnourished elderly (≥ 60 y) patients. Patients in the intervention group received nutritional supplementation (energy and protein enriched diet, oral nutritional support, calcium-vitamin D supplement, telephone counselling by a dietician) until three months after discharge from hospital. Patients in the control group received usual care (control). Primary outcomes were Quality Adjusted Life Years (QALYs), physical activities and functional limitations. Measurements were performed at hospital admission and three months after discharge. Data were analyzed according to the intention-to-treat principle and multiple imputation was used to impute missing data. Incremental cost-effectiveness ratios were calculated and bootstrapping was applied to evaluate cost-effectiveness. Cost-effectiveness was expressed by cost-effectiveness planes and cost-effectiveness acceptability curves.
210 patients were included, 105 in each group. After three months, no statistically significant differences in quality of life and physical activities were observed between groups. Functional limitations decreased significantly more in the intervention group (mean difference -0.72, 95% CI-1.15; -0.28). There were no differences in costs between groups. Cost-effectiveness for QALYs and physical activities could not be demonstrated. For functional limitations we found a 0.95 probability that the intervention is cost-effective in comparison with usual care for ceiling ratios > €6500.
A multi-component nutritional intervention to malnourished elderly patients for three months after hospital discharge leads to significant improvement in functional limitations and is neutral in costs. A follow-up of three months is probably too short to detect changes in QALYs or physical activities.
老年人易发生营养不良，这会导致医疗保健费用增加。本研究旨在从社会角度评估营养补充的成本效益。
这是一项随机对照试验，纳入了住院的营养不良老年人（≥60 岁）患者。干预组患者接受营养补充（能量和蛋白质丰富的饮食、口服营养支持、钙-维生素 D 补充剂、营养师电话咨询），直到出院后三个月。对照组患者接受常规护理（对照）。主要结局是质量调整生命年（QALYs）、身体活动和功能限制。在入院时和出院后三个月进行测量。根据意向治疗原则进行数据分析，并采用多重插补法来插补缺失数据。计算增量成本效益比，并采用自举法评估成本效益。成本效益用成本效益平面和成本效益接受曲线表示。
共纳入 210 例患者，每组 105 例。三个月后，两组患者的生活质量和身体活动均无统计学差异。干预组的功能限制显著降低（平均差异-0.72，95%CI-1.15；-0.28）。两组之间的成本无差异。无法证明 QALYs 和身体活动的成本效益。对于功能限制，我们发现干预组与常规护理相比，在 ceiling 比值>€6500 时，有 0.95 的概率具有成本效益。
对出院后三个月的营养不良老年患者进行多组分营养干预可显著改善功能限制，且成本中性。三个月的随访时间可能太短，无法检测 QALYs 或身体活动的变化。
