Economic Evaluation of Individualized Nutritional Support for Hospitalized Patients with Chronic Heart Failure

Abstract

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.

Nutritional support during the hospital stay is cost-effective for preventing adverse outcomes in patients with cancer

“…As for all modeling analyses, our model had limitations as previously reported ( 10 , 11 ). Of note, the calculation of costs and cost savings was informed from the perspective of the Swiss hospitals included in the original EFFORT trial ( 29 ), which may not be representative of other hospitals worldwide.…”

“…The objective of our present analysis was to determine whether the recovery benefits of nutritional support were paralleled by cost-effectiveness of this nutritional care. For our current cost-effectiveness analysis, we examined hospital costs and health outcomes in patients with cancer, using modeling to compare results for the nutritional intervention and control groups, as we have done previously for poorly nourished medical inpatients ( 10 ) and for patients with chronic heart failure ( 11 ). We used clinical data of patients with cancer included in the EFFORT trial – the largest randomized trial today outside critical care that compared clinical outcomes among patients receiving individualized nutritional support with usual hospital care ( 6 ).…”

Diagnosis and Management of Malnutrition in Patients with Heart Failure

“…However, in terms of complications, patients receiving nutritional support had a cost savings of 6214 SF and an additional 4.11 life days without complications, with an incremental cost-effectiveness ratio for avoided complications of 1513 SF per life day gained. Thus, the economic analysis concluded that in-hospital nutritional support for chronic HF patients increased life expectancy at an acceptable incremental cost-effectiveness ratio [95].…”

The Effects of Nutrition on Chronic Conditions

“…Malnutrition is prevalent among patients with chronic heart failure (CHF) due to the lack of appetite, unintentional weight loss, impaired intestinal function, catabolic metabolism, and other comorbidities. Schuetz et al [13] investigated the cost-effectiveness of an individualised nutritional therapy in 645 hospitalised patients with CHF. The authors found that the overall incremental cost-effectiveness ratio for the individualised nutritional therapy vs. no nutritional therapy was 2625 Swiss Francs per life day gained.…”

“…The authors found that the overall incremental cost-effectiveness ratio for the individualised nutritional therapy vs. no nutritional therapy was 2625 Swiss Francs per life day gained. They concluded that the intervention increased life expectancy at an acceptable incremental cost-effectiveness ratio [13].…”