Internal Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
University of Basel, Basel, Swizerland.
BMJ Open. 2021 Jul 9;11(7):e046402. doi: 10.1136/bmjopen-2020-046402.
Nutritional support improves clinical outcomes during hospitalisation as well as after discharge. Recently, a systematic review of 27 randomised, controlled trials showed that nutritional support was associated with lower rates of hospital readmissions and improved survival. In the present economic modelling study, we sought to determine whether in-hospital nutritional support would also return economic benefits.
The current economic model applied cost estimates to the outcome results from our recent systematic review of hospitalised patients. In the underlying meta-analysis, a total of 27 trials (n=6803 patients) were included. To calculate the economic impact of nutritional support, a Markov model was developed using transitions between relevant health states. Costs were estimated accounting for length of stay in a general hospital ward, hospital-acquired infections, readmissions and nutritional support. Six-month mortality was also considered. The estimated daily per-patient cost for in-hospital nutrition was US$6.23.
Overall costs of care within the model timeframe of 6 months averaged US$63 227 per patient in the intervention group versus US$66 045 in the control group, which corresponds to per patient cost savings of US$2818. These cost savings were mainly due to reduced infection rate and shorter lengths of stay. We also calculated the costs to prevent a hospital-acquired infection and a non-elective readmission, that is, US$820 and US$733, respectively. The incremental cost per life-day gained was -US$1149 with 2.53 additional days. The sensitivity analyses for cost per quality-adjusted life day provided support for the original findings.
For medical inpatients who are malnourished or at nutritional risk, our findings showed that in-hospital nutritional support is a cost-effective way to reduce risk for readmissions, lower the frequency of hospital-associated infections, and improve survival rates.
营养支持可改善住院期间和出院后的临床结局。最近，对 27 项随机对照试验的系统评价显示，营养支持与较低的再入院率和改善的生存率相关。在本项经济建模研究中，我们旨在确定住院期间的营养支持是否也会带来经济效益。
当前的经济模型将我们近期对住院患者的系统评价的结局结果应用于成本估计。在基础的荟萃分析中，共纳入 27 项试验（n=6803 例患者）。为了计算营养支持的经济影响，使用相关健康状态之间的转移情况开发了一个 Markov 模型。成本根据普通病房住院时间、医院获得性感染、再入院和营养支持进行了估计。还考虑了 6 个月的死亡率。住院期间营养的估计每日每位患者费用为 6.23 美元。
在 6 个月的模型时间内，总体护理成本在干预组中平均为每位患者 63227 美元，而在对照组中为 66045 美元，这对应于每位患者节省 2818 美元的费用。这些成本节约主要归因于感染率降低和住院时间缩短。我们还计算了预防医院获得性感染和非择期再入院的成本，分别为 820 美元和 733 美元。每获得一天生命的增量成本为-1149 美元，额外增加 2.53 天。每质量调整生命日的增量成本分析为原始发现提供了支持。
对于营养不良或存在营养风险的住院患者，我们的研究结果表明，住院期间的营养支持是一种降低再入院风险、降低医院相关感染频率和提高生存率的具有成本效益的方法。
