Medical University Department, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland.
Abbott Nutrition, Chicago, IL, USA.
Clin Nutr. 2020 Nov;39(11):3361-3368. doi: 10.1016/j.clnu.2020.02.023. Epub 2020 Feb 25.
BACKGROUND & AIMS: Existing guidelines support the importance of nutritional interventions for medical inpatients at malnutrition risk to alleviate the impact of malnutrition on outcomes. While recent studies have reported positive effects of nutritional support on health outcomes, limited evidence exists on whether in-hospital nutritional support also results in economic advantages. We report the results of the economic evaluation of EFFORT-a pragmatic, investigator-initiated, open-label, multicenter trial.
A total of 2028 medical inpatients at nutritional risk were randomly assigned to receive individualized nutritional support to reach protein and energy goals (intervention group; n = 1015) or standard hospital food (control group; n = 1013). To calculate the economic impact of nutritional support, a Markov model was developed with relevant health states. Costs were estimated for days in normal hospital ward and in the Intensive Care Unit (ICU), hospital-acquired complications, and nutritional support. We used a Euro conversion rate of 0.93216 Euro for 1 Swiss Franc (CHF).
The estimated per-patient cost was CHF90 (83.78 €) for the in-hospital nutritional support and CHF283.85 (264.23 €) when also considering dietitian consultation time. Overall costs of care within 30 days of admission averaged CHF29,263 (27,240 €) per-patient in the intervention group versus CHF29,477 (27,439 €) in the control group resulting in per-patient cost savings of CHF214 (199 €). Per-patient cost savings was CHF19.56 (18.21 €) when also accounting for dietician costs (full cost analysis). These cost savings were mainly due to reduced ICU length of stay and fewer complications. We also calculated costs to prevent adverse outcomes, which were CHF276 (256 €) for one severe complication, CHF2,675 (2490 €) for one day in ICU, and CHF7,975 (7423 €) for one death. For the full cost analysis, these numbers were CHF872 (811 €), CHF8,459 (7874 €) and CHF25,219 (23,475 €). Sensitivity analyses confirmed the original findings.
Our evaluation demonstrates that in-hospital nutritional support for medical inpatients is a highly cost-effective intervention to reduce risks for ICU admissions and hospital-associated complications, while improving patient survival. The positive clinical and economic benefits of nutritional support in at-risk medical inpatients calls for comprehensive nutrition programs, including malnutrition screening, consultation, and nutritional support.
ClinicalTrials.gov number, NCT02517476.
现有的指南支持对有营养不良风险的住院患者进行营养干预，以减轻营养不良对结局的影响。尽管最近的研究报告了营养支持对健康结局的积极影响，但关于住院期间的营养支持是否也具有经济效益的证据有限。我们报告了 EFFORT 研究的经济学评价结果，这是一项实用的、由研究者发起的、开放性标签、多中心试验。
共 2028 名有营养不良风险的住院患者被随机分配接受个体化营养支持以达到蛋白质和能量目标（干预组，n=1015）或接受标准医院饮食（对照组，n=1013）。为了计算营养支持的经济影响，我们使用相关的健康状态开发了一个 Markov 模型。计算了在普通病房和重症监护病房（ICU）住院天数、医院获得性并发症和营养支持的费用。我们使用 1 瑞士法郎（CHF）兑换 0.93216 欧元的汇率。
每位患者的住院期间营养支持费用为 CHF90（83.78 欧元），如果同时考虑营养师咨询时间，则为 CHF283.85（264.23 欧元）。干预组患者入院后 30 天内的平均医疗费用为 CHF29263（27240 欧元）/人，对照组为 CHF29477（27439 欧元）/人，干预组每位患者的成本节省了 CHF214（199 欧元）。如果同时考虑营养师费用（全成本分析），每位患者的成本节省为 CHF19.56（18.21 欧元）。这些成本节省主要归因于 ICU 住院时间缩短和并发症减少。我们还计算了预防不良结局的成本，即严重并发症 1 例 CHF276（256 欧元），ICU 住院 1 天 CHF2675（2490 欧元），死亡 1 例 CHF7975（7423 欧元）。对于全成本分析，这些数字分别为 CHF872（811 欧元）、CHF8459（7874 欧元）和 CHF25219（23475 欧元）。敏感性分析证实了最初的发现。
我们的评估表明，对住院患者进行院内营养支持是一种非常具有成本效益的干预措施，可以降低 ICU 入院和医院相关并发症的风险，同时提高患者生存率。营养支持对有风险的住院患者具有积极的临床和经济效益，呼吁建立全面的营养计划，包括营养不良筛查、咨询和营养支持。
ClinicalTrials.gov 编号，NCT02517476。
