Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland.
Medical Faculty, University of Basel, 4001 Basel, Switzerland.
Nutrients. 2022 Apr 20;14(9):1703. doi: 10.3390/nu14091703.
Background Malnutrition is a highly prevalent risk factor in hospitalized patients with chronic heart failure (CHF). A recent randomized trial found lower mortality and improved health outcomes when CHF patients with nutritional risk received individualized nutritional treatment. Objective To estimate the cost-effectiveness of individualized nutritional support in hospitalized patients with CHF. Methods This analysis used data from CHF patients at risk of malnutrition (N = 645) who were part of the Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial (EFFORT). Study patients with CHF were randomized into (i) an intervention group (individualized nutritional support to reach energy, protein, and micronutrient goals) or (ii) a control group (receiving standard hospital food). We used a Markov model with daily cycles (over a 6-month interval) to estimate hospital costs and health outcomes in the comparator groups, thus modeling cost-effectiveness ratios of nutritional interventions. Results With nutritional support, the modeled total additional cost over the 6-month interval was 15,159 Swiss Francs (SF). With an additional 5.77 life days, the overall incremental cost-effectiveness ratio for nutritional support vs. no nutritional support was 2625 SF per life day gained. In terms of complications, patients receiving nutritional support had a cost savings of 6214 SF and an additional 4.11 life days without complications, yielding an incremental cost-effectiveness ratio for avoided complications of 1513 SF per life day gained. Conclusions On the basis of a Markov model, this economic analysis found that in-hospital nutritional support for CHF patients increased life expectancy at an acceptable incremental cost-effectiveness ratio.
营养不良是慢性心力衰竭（CHF）住院患者的一个高发风险因素。最近的一项随机试验发现，对于存在营养风险的 CHF 患者给予个体化营养治疗，可降低死亡率并改善健康结局。目的：评估个体化营养支持在 CHF 住院患者中的成本效益。方法：本分析使用了来自有营养不良风险的 CHF 患者（N=645）的数据，这些患者是早期营养治疗对衰弱、功能结局和营养不良医疗住院患者恢复的影响（EFFORT）试验的一部分。CHF 患者被随机分为（i）干预组（个体化营养支持以达到能量、蛋白质和微量营养素目标）或（ii）对照组（接受标准医院饮食）。我们使用具有每日循环（6 个月间隔）的 Markov 模型来估计对照组的医院成本和健康结局，从而对营养干预的成本效益比进行建模。结果：有营养支持时，6 个月间隔内的模型总附加成本为 15159 瑞士法郎（SF）。有额外的 5.77 个生命日，营养支持相对于无营养支持的总体增量成本效益比为每获得 1 个生命日增加 2625SF。在并发症方面，接受营养支持的患者节省了 6214SF 且无并发症的额外生命日为 4.11 天，避免并发症的增量成本效益比为每获得 1 个生命日增加 1513SF。结论：基于 Markov 模型，这项经济分析发现，对 CHF 患者进行住院营养支持可在可接受的增量成本效益比上提高预期寿命。
