Wong Alvin, Huang Yingxiao, Banks Merrilyn D, Sowa P Marcin, Bauer Judy D
Department of Dietetics, Changi General Hospital, Singapore 529889, Singapore.
School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4072, Australia.
Healthcare (Basel). 2024 May 17;12(10):1041. doi: 10.3390/healthcare12101041.
Malnutrition is a significant and prevalent issue in hospital settings, associated with increased morbidity and mortality, longer hospital stays, higher readmission rates, and greater healthcare costs. Despite the potential impact of nutritional interventions on patient outcomes, there is a paucity of research focusing on their economic evaluation in the hospital setting. This study aims to fill this gap by conducting a cost-consequence analysis (CCA) of nutritional interventions targeting malnutrition in the hospital setting.
We performed a CCA using data from recent systematic reviews and meta-analyses, focusing on older adult patients with or at risk of malnutrition in the hospital setting. The analysis included outcomes such as 30-day, 6-month, and 12-month mortality; 30-day and 6-month readmissions; hospital complications; length of stay; and disability-adjusted life years (DALYs). Sensitivity analyses were conducted to evaluate the impact of varying success rates in treating malnutrition and the proportions of malnourished patients seen by dietitians in SingHealth institutions.
The CCA indicated that 28.15 DALYs were averted across three SingHealth institutions due to the successful treatment or prevention of malnutrition by dietitians from 1 April 2021 to 31 March 2022, for an estimated 45,000 patients. The sensitivity analyses showed that the total DALYs averted ranged from 21.98 (53% success rate) to 40.03 (100% of malnourished patients seen by dietitians). The cost of implementing a complex nutritional intervention was USD 218.72 (USD 104.59, USD 478.40) per patient during hospitalization, with additional costs of USD 814.27 (USD 397.69, USD 1212.74) when the intervention was extended for three months post-discharge and USD 638.77 (USD 602.05, USD 1185.90) for concurrent therapy or exercise interventions.
Nutritional interventions targeting malnutrition in hospital settings can have significant clinical and economic benefits. The CCA provides valuable insights into the costs and outcomes associated with these interventions, helping healthcare providers and policymakers to make informed decisions on resource allocation and intervention prioritization.
营养不良是医院环境中一个重大且普遍存在的问题，与发病率和死亡率增加、住院时间延长、再入院率升高以及医疗成本增加相关。尽管营养干预对患者预后有潜在影响，但针对医院环境中营养干预的经济评估研究却很少。本研究旨在通过对医院环境中针对营养不良的营养干预进行成本后果分析（CCA）来填补这一空白。
我们使用近期系统评价和荟萃分析的数据进行了CCA，重点关注医院环境中患有营养不良或有营养不良风险的老年患者。分析包括30天、6个月和12个月死亡率；30天和6个月再入院率；医院并发症；住院时间；以及伤残调整生命年（DALYs）等结果。进行了敏感性分析，以评估治疗营养不良成功率的变化以及新加坡健康集团机构中营养师诊治的营养不良患者比例的影响。
CCA表明，2021年4月1日至2022年3月31日期间，新加坡健康集团的三家机构因营养师成功治疗或预防营养不良，为估计45000名患者避免了28.15个伤残调整生命年。敏感性分析表明，避免的总伤残调整生命年数在21.98（成功率53%）至40.03（营养师诊治100%的营养不良患者）之间。住院期间实施复杂营养干预的成本为每位患者218.72美元（104.59美元，478.40美元），出院后干预延长三个月时额外成本为814.27美元（397.69美元，1212.74美元），同时进行治疗或运动干预的成本为638.77美元（602.05美元，1185.90美元）。
医院环境中针对营养不良的营养干预可带来显著的临床和经济效益。成本后果分析为这些干预的成本和结果提供了有价值的见解，有助于医疗保健提供者和政策制定者在资源分配和干预优先级方面做出明智决策。
