Value of Nutrition Support Therapy: Impact on Clinical and Economic Outcomes in the United States

Abstract

Objective Healthcare leaders seek guidance on prudent investment in programs that improve patient outcomes and reduce costs, which includes the value of nutrition therapy. The purpose of this project was to conduct an evidence review and evaluate claims analyses to understand the financial and quality impact of nutrition support therapy on high‐priority therapeutic conditions. Methods Task 1 included a review of existing literature from 2013 to 2018 to identify evidence that demonstrated the clinical and economic impact of nutrition intervention on patient outcomes across 13 therapeutic areas (TAs). In Task 2, analytic claims modeling was performed using the Medicare Parts A and B claims 5% sample dataset. Beneficiaries diagnosed in 5 selected TAs (sepsis, gastrointestinal [GI] cancer, hospital‐acquired infections, surgical complications, and pancreatitis) were identified in the studies from Task 1, and their care costs were modeled based on nutrition intervention. Results Beginning with 1099 identified articles, 43 articles met the criteria, with a final 8 articles used for the Medicare claims modeling. As examples of the modeling demonstrated, the use of advanced enteral nutrition formula could save at least $52 million annually in a sepsis population. The total projected annual cost savings from the 5 TAs was $580 million. Conclusion Overall, optimization of nutrition support therapy for specific patient populations is estimated to reduce Medicare spending by millions of dollars per year across key TAs. These findings demonstrate the evidence‐based value proposition of timely nutrition support to improve clinical outcomes and yield substantial cost savings.

Hospital nutrition care informs potential cost-savings for healthcare: A budget impact analysis

“…As well, results of a systematic review and meta-analysis showed that nutrition intervention with ONS reduced mortality risk by 35%, reduced complications by 35%, and reduced length of hospital stay by approximately 2 days or approximately 13% reduction [29]. Findings in a recent review and cost analysis indicated that the US Medicare system could save as much as $580 million annually by providing nutrition-focused care in 5 key therapeutic areas (sepsis, gastrointestinal cancer, hospital-acquired infections, surgical complications, and pancreatitis) [30]. Finally, a large multi-center randomized controlled study of 2088 patients in Switzerland (EFFORT trial) demonstrated that early nutrition therapy (ONS provision within 48 h of hospital admission) among malnourished hospitalized patients reduced adverse clinical outcomes including 30-day mortality, while improving functional outcomes and quality of life [31].…”

Value of nutrition support therapy in patients with gastrointestinal malignancies: a narrative review and health economic analysis of impact on clinical outcomes in the United States

“…The approach taken was to model nutrition interventions that could significantly improve clinical outcomes. Specifically, the GI cancer workgroup, a multidisciplinary section of the ASPEN value project, evaluated a targeted review of the literature which combined keywords in the areas of therapeutic nutrition (nutrition, malnutrition), a specific therapeutic area of GI cancers, study parameters (clinical outcomes, healthcare costs) previously conducted by the Value Project team, the complete list of terms used is in Table 2 (24). This search was conducted using PubMed and Google Scholar in 5-year look-back period, for human trials and papers in English, published in both her US & International.…”

“…The GI cancer workgroup, then searched for more recent [2018][2019] high-evidence papers [metaanalyses of randomized controlled trials (RCTs), narrative/ systematic reviews of RCTs, recent individual RCTs], using human studies, and papers in English. A literature assessment rubric that was developed by the ASPEN Value Project group was used to evaluate each article identified in the search to select publications for inclusion in the final analysis (24). The rubric, consisted of 4 domains with a point-based scoring system: (I) level of evidence using the GRADE evidence scale (1 to 5), (II) outcomes of interest (0 to 3), (III) type of nutrition intervention (0 to 4), (IV) scalability (1 to 4) (24).…”

<p>Nutrition Interventions Deliver Value in Healthcare: Real-World Evidence</p>

“…5 Based on this analysis and other work, healthcare decision-makers worldwide have likewise begun to realize that therapeutic nutrition plays important and cost-saving roles in overall care, ie, the value of nutrition care. [6][7][8][9][10] To highlight value in nutrition care, this paper will review evidence of the health and financial tolls of disease-associated malnutrition in hospitals, report realworld results from nutrition-focused quality improvement programs (QIPs) in hospitals, and discuss clinical and policy implications of value in nutrition care for hospitalized patients with disease-associated malnutrition.…”