Kapedanovska Nestorovska Aleksandra, Sterjev Zoran
Center for Medication Therapy Management, Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia.
Clinicoecon Outcomes Res. 2025 Mar 26;17:265-276. doi: 10.2147/CEOR.S504094. eCollection 2025.
This study aimed to assess the cost-effectiveness of medical nutritional support in a cancer care program in North Macedonia, comparing specialized oral nutritional supplements (ONS) with the standard of care (SOC) in managing disease-related malnutrition (DRM) in patients with or at risk of tumor cachexia syndrome.
A previously published decision tree model was employed to evaluate the economic impact of supportive treatment in cancer patients eligible for ONS. Monthly transition probabilities between health states, length of hospital stay for each treatment strategy, and utility parameters were derived from the literature. For base-case analysis, the cancer care program duration was set at 30 days. The analysis was conducted from the perspective of a national health insurance fund, utilizing a 13-year time horizon with monthly cycles. Only direct supportive care costs, estimated from publicly available data, were considered. Quality-adjusted life-years (QALYs) gained per patient and associated costs were calculated, with outcomes and costs discounted at 3.0% annually. One-way and probabilistic sensitivity analyses were performed to assess results robustness.
In the base case analysis, ONS was the dominant treatment strategy, with total costs per patient of €2605.01 for ONS versus €3759.23 for SOC, indicating a significant cost reduction. Reduced hospitalization expenses outweighed the higher acquisition costs of ONS. Additionally, ONS provided greater health benefits, achieving 8.21 QALY vs 7.91QALY in the SOC group. The resulting Incremental Cost-Effectiveness Ratio (ICER) was negative, reinforcing ONS as the dominant strategy. Sensitivity analyses confirmed that the cost-effectiveness was primarily driven by cancer program duration, with cost-saving benefits up to 132 days.
Our findings demonstrate that specialized ONS is a cost-effective treatment option within a cancer care program compared with SOC. While this study focuses on North Macedonia, the results are applicable to countries with similar economic and healthcare structures, reinforcing ONS as a valuable intervention across comparable healthcare systems.
本研究旨在评估北马其顿癌症护理项目中医学营养支持的成本效益，比较专门的口服营养补充剂（ONS）与标准护理（SOC）在管理肿瘤恶病质综合征患者或有肿瘤恶病质综合征风险患者的疾病相关营养不良（DRM）方面的效果。
采用先前发表的决策树模型来评估符合ONS条件的癌症患者支持性治疗的经济影响。健康状态之间的月度转移概率、每种治疗策略的住院时间长度以及效用参数均来自文献。对于基础案例分析，癌症护理项目持续时间设定为30天。分析是从国家健康保险基金的角度进行的，采用13年的时间范围，以月为周期。仅考虑从公开可用数据估计的直接支持性护理成本。计算每位患者获得的质量调整生命年（QALY）和相关成本，结果和成本按每年3.0%进行贴现。进行单向和概率敏感性分析以评估结果的稳健性。
在基础案例分析中，ONS是主要治疗策略，ONS每位患者的总成本为2605.01欧元，而SOC为3759.23欧元，表明成本显著降低。住院费用的减少超过了ONS较高的购置成本。此外，ONS提供了更大的健康益处，在SOC组中实现了8.21个QALY，而SOC组为7.91个QALY。由此产生的增量成本效益比（ICER）为负，进一步证明ONS是主要策略。敏感性分析证实，成本效益主要由癌症项目持续时间驱动，成本节约效益可达132天。
我们的研究结果表明，与SOC相比，专门的ONS在癌症护理项目中是一种具有成本效益的治疗选择。虽然本研究聚焦于北马其顿，但结果适用于具有类似经济和医疗结构的国家，强化了ONS作为跨可比医疗系统的有价值干预措施的地位。
