Efficiency, cost-effectiveness and need of inversion in nutritional therapy. Importance of detecting and documenting undernutrition

López, Jesús Manuel Morán; León, María Piedra; Moralejo, Belén Beneítez; Izquierdo, Fidel Jesús Enciso; Pérez, Luis Miguel Luengo; Señaris, José Antonio Amado

doi:10.1016/j.clnesp.2016.03.004

Cited by 10 publications

(8 citation statements)

References 12 publications

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“…Despite the high prevalence of malnutrition, its clinical and financial consequences and recommendations for diagnosis and treatment of this condition in malnourished patients [ 29 , 30 ], this is still an underdiagnosed and undertreated condition in Spain. Observational studies carried out in Spain have noted that only 5% of hospital discharges recognise malnutrition as a diagnosis [ 6 ], and only 25% of malnourished patients receive any type of ONS [ 5 ]. Therefore, it is necessary to implement measures to improve the diagnosis and treatment of malnutrition in specialised units.…”

Section: Discussionmentioning

confidence: 99%

“…Malnutrition is a common condition in hospitalised patients. Observational studies carried out in Spanish hospitals have estimated a prevalence of malnutrition of between 23% and 70% [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ], depending on the population assessed and the screening and assessment tools used. Advanced age is a known risk factor for malnutrition [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness of a Specialized Oral Nutritional Supplementation for Malnourished Older Adult Patients in Spain

Ballesteros-Pomar¹,

Llinàs²,

Goates³

et al. 2018

Nutrients

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Malnutrition has been related to prolonged hospital stays, and to increases in readmission and mortality rates. In the NOURISH (Nutrition effect On Unplanned Readmissions and Survival in Hospitalized patients) study, administering a high protein oral nutritional supplement (ONS) containing beta-hydroxy-beta-methylbutyrate (HP-HMB) to hospitalised older adult patients led to a significant improvement in survival compared with a placebo treatment. The aim of this study was to determine whether HP-HMB would be cost-effective in Spain. We performed a cost-effectiveness analysis from the perspective of the Spanish National Health System using time horizons of 90 days, 180 days, 1 year, 2 years, 5 years and lifetime. The difference in cost between patients treated with HP-HMB and placebo was €332.75. With the 90 days time horizon, the difference in life years gained (LYG) between both groups was 0.0096, resulting in an incremental cost-effectiveness ratio (ICER) of €34,700.62/LYG. With time horizons of 180 days, 1 year, 2 years, 5 years and lifetime, the respective ICERs were €13,711.68, €3377.96, €2253.32, €1127.34 and €563.84/LYG. This analysis suggests that administering HP-HMB to older adult patients admitted to Spanish hospitals during hospitalisation and after discharge could be a cost-effective intervention that would improve survival with a reduced marginal cost.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of a Specialized Oral Nutritional Supplementation for Malnourished Older Adult Patients in Spain

Ballesteros-Pomar¹,

Llinàs²,

Goates³

et al. 2018

Nutrients

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“…The cost of nutritional care needed to shorten the mean length of hospital stay by one day for all malnourished patients was $91. Moreover, according to Morán López et al [20] proper detection of disease related malnutrition might prevent the loss of 16.8 % of health expenses (approximately €424.785) and justify €343.291 reimbursement for nutritional diagnoses and processes.…”

Section: Clinical and Cost Benefits For Nutritional Management Of Nonmentioning

confidence: 99%

Role of nutritional support provided by qualified dietitians in the prevention and treatment of non-communicable diseases

Bednarczuk

Czekajło-Kozłowska

2019

Rocz Panstw Zakl Hig

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The role of dietitians is to counsel patients on special dietary modifications, develop dietary plans and provide dietary advice for healthy lifestyle in order to promote health and prevent disease. As lifestyle changes have become a primary reason for the increasing prevalence of non-communicable diseases in recent decades, it appears that nutritional therapy should play an important role in the multidisciplinary healthcare system. The aim of the review was to evaluate the role of nutritional support provided by dietitians in the prevention and treatment of chronic diseases in terms of its clinical and cost-effectiveness, according to their range of activity and qualifications. The evaluation was based on the review of the current literature. The costs of the treatment of non-communicable diseases encompass the costs of the treatment of the disease itself, costs of its complications and costs resulting from the decline of the productivity of patients. The results of studies indicate that nutritional support provides not only clinical but also cost benefits in the prevention and treatment of various non-communicable diseases. Every €1 spend on dietary counseling of patients with obesity or obesity-related diseases approximately returns a net €14 to €63 over a period of five years. Dietitians appear to be more effective in counseling overweight or obese patients with present risk factors compared to other specialists, however the barriers to accessing a qualified dietitian and problems with the reimbursement for services still exist. As adequate professional qualifications of dietitians appear to be an important factor determining the effectiveness of implemented dietary care, an additional training courses for dietitians and enhanced cooperation of hospitals and medical universities are needed.

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“…In the 9-month study by Mor an et al, which analysed 160 discharge reports, the authors detected that DRM diagnosis was coded only in 6.2% of discharge reports. After correctly coding such diagnosis, DRG increased 103.3 points, which resulted in an additional reimbursement of 343,291.20V [6].…”

Section: Introductionmentioning

confidence: 99%

The economic cost of not coding disease-related malnutrition: A study in cancer inpatients

Bolívar¹,

Ruiz-García

Contreras-Bolívar

et al. 2022

Clinical Nutrition

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Background & aims: Disease-related malnutrition (DRM) coding rate is usually low in hospitalised patients. The objective of our study was to estimate the percentage of correct DRM coding in cancer inpatients and to calculate the economic losses caused by such lack of coding. Methods: This was an observational, prospective study that was conducted in patients hospitalised in the Medical Oncology Unit of our hospital. A nutritional assessment was performed through subjective global assessment (SGA). The all patient refined-diagnosis related group (APR-DRG) weights were obtained at the moment of discharge; moreover, recalculation was done after including the diagnosis of malnutrition in the medical record of those patients in whom it had not been initially coded. The associated cost reimbursement were calculated based on the weight before and after revising the diagnosis of DRM. Results: A total of 266 patients were evaluated. From them, 220 (82.7%) suffered from DRM according to the SGA. In 137 (51.5%) of these patients, diagnosis was coded, as opposed to 83 (31.2%) cases (33 subjects with moderate and 50 with severe DRM) in whom it was not coded. The sum of the APR-DRG weights before revising the diagnosis of malnutrition was 343.4 points (mean: 1.29 ± 0.89). Whereas, after revising the diagnosis, it increased up to 384.3 (1.44 ± 0.96). The total cost reimbursement for the hospital before revising the diagnosis of malnutrition was 1,607,861.21V and after revision it increased up to 1,799,199.69V, which means that 191,338.48V were not reimbursed to the hospital due to the lack of coding of malnutrition. The cost reimbursement for each admission increased an average of 719.32V. Conclusion:The prevalence of DRM in cancer inpatients is high. Nevertheless, the diagnosis is not coded in one third of patients, which results in important economic losses for the hospitals.

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Efficiency, cost-effectiveness and need of inversion in nutritional therapy. Importance of detecting and documenting undernutrition

Cited by 10 publications

References 12 publications

Cost-Effectiveness of a Specialized Oral Nutritional Supplementation for Malnourished Older Adult Patients in Spain

Cost-Effectiveness of a Specialized Oral Nutritional Supplementation for Malnourished Older Adult Patients in Spain

Role of nutritional support provided by qualified dietitians in the prevention and treatment of non-communicable diseases

The economic cost of not coding disease-related malnutrition: A study in cancer inpatients

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