Freijer Karen, van Puffelen Esther, Joosten Koen F, Hulst Jessie M, Koopmanschap Marc A
Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box, 616, 6200 MD Maastricht, The Netherlands.
Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
Clin Nutr ESPEN. 2018 Feb;23:228-233. doi: 10.1016/j.clnesp.2017.09.009. Epub 2017 Oct 13.
Disease related malnutrition (DRM) is a serious medical condition which is associated with an increase in morbidity and mortality, augmenting resource use and associated costs. DRM can be detected by actively and fully assessing the nutritional status. Studies in adult malnourished patients have shown that the additional health care costs are about € 2 billion (€ 2000 million) per year. The objective of the current study was to estimate the annual additional costs of DRM for pediatric patients as was done for adults.
A cost-of-illness analysis was performed to calculate the annual additional costs of DRM in 2015 pediatric patients (aged 1 month up to and including 17 years) admitted to non-academic hospitals in The Netherlands. DRM was assessed with weight-for-age, weight-for-height and height-for-age. Input variables in the formula used were length of stay and prevalence of DRM. The costs were estimated per disease as classified in the International Classification of Diseases by the WHO (ICD-10), per gender and age group. The results were expressed as an absolute monetary value as well as a percentage of the Dutch national health expenditure. Robustness of the results was checked by a sensitivity analysis.
The total additional direct medical costs of DRM in pediatric patients in 2013 were estimated to be € 51 million for acute malnutrition, € 46 million when focused on chronic malnutrition and € 80 million in case of overall malnourished children. This equals 5.6% of the total Dutch hospital costs for these hospitalized children.
This study has shown that DRM in hospitalized children is associated with an increase in annual hospital costs with an additional amount of € 80 million, of which acute malnutrition account for the largest part.
疾病相关营养不良（DRM）是一种严重的医学状况，与发病率和死亡率增加、资源使用及相关成本上升有关。通过积极全面地评估营养状况可检测出DRM。对成年营养不良患者的研究表明，每年额外的医疗保健成本约为20亿欧元（20亿€）。本研究的目的是像对成人那样估算儿科患者DRM的年度额外成本。
进行了一项疾病成本分析，以计算2015年荷兰非学术医院收治的儿科患者（年龄1个月至17岁）DRM的年度额外成本。采用年龄别体重、身高别体重和年龄别身高来评估DRM。所用公式中的输入变量为住院时间和DRM患病率。成本按世界卫生组织（WHO）《国际疾病分类》（ICD - 10）分类的每种疾病、按性别和年龄组进行估算。结果以绝对货币价值以及占荷兰国家卫生支出的百分比表示。通过敏感性分析检查结果的稳健性。
2013年儿科患者DRM的额外直接医疗总成本估计为：急性营养不良5100万€，关注慢性营养不良时为4600万€，整体营养不良儿童为8000万€。这相当于这些住院儿童荷兰医院总成本的5.6%。
本研究表明，住院儿童的DRM与年度医院成本增加8000万€相关，其中急性营养不良占最大部分。
