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Aim To define and quantify hospital‐acquired malnutrition, including the concept of preventable and non‐preventable malnutrition; and identify the main causes of preventable malnutrition. Furthermore, demonstrate potential cost‐savings for a quaternary hospital in Sydney (Australia) if a theoretical model of preventable malnutrition was applied to the penalties associated with hospital‐acquired malnutrition, compared to the current government framework. Methods A retrospective audit was conducted on electronic medical records reassessing cases of hospital‐acquired malnutrition previously identified by dietitians or medical coders. Costs were calculated using the Independent Hospital Pricing Authority's (IHPA) pricing principles for hospital‐acquired complications (version 3, 2018). Results Twenty‐three patients of 15 419 admissions were identified with hospital‐acquired malnutrition in the 3‐month study period. Sixteen cases (70%) were classified as preventable, two cases (9%) were classified as non‐preventable, and five cases were non‐hospital‐acquired cases of malnutrition. Under the IHPA proposed costing model, total cost of all hospital‐acquired malnutrition to the hospital is estimated to be $162 600 over 3 months. The theoretical model of preventable malnutrition resulted in a cost penalty of only $98 600, which is a hospital cost‐saving of $64 000 (or 40% of the overall penalty) when compared to the current government framework. Conclusions The majority of hospital‐acquired malnutrition cases were found to have a preventable component. It is proposed that a costing model that penalises hospitals for only preventable hospital‐acquired malnutrition be considered, which would permit hospitals to focus on addressing preventable (and thus actionable) causes of hospital‐acquired malnutrition with not only potential health benefits to patients but cost‐savings to hospitals.

The FDA approved pembrolizumab on June 29, 2020, for the treatment of patients with unresectable or metastatic microsatellite instability-high (MSI-H) colorectal cancer with no prior systemic treatment for advanced disease. The approval was based on data from Study Keynote-177, which randomly allocated patients to receive either pembrolizumab or standard of care (SOC) with chemotherapy. Overall survival (OS) and independently assessed progression-free survival (PFS) were the primary endpoints. At the time of the final PFS analysis and second prespecified interim OS analysis, the estimated median PFS was 16.5 months (95% CI: 5.4–32.4) versus 8.2 months (95% CI: 6.1–10.2) in the pembrolizumab and SOC arms, respectively [HR: 0.60 (95% CI: 0.45–0.80); two-sided P = 0.0004]. FDA assessed unblinded OS data during the review of the application and identified no safety concerns that would preclude approval of this supplement. Adverse reactions occurring in >30% of patients receiving pembrolizumab were diarrhea, fatigue/asthenia, and nausea. Adverse reactions occurring in >30% of patients receiving SOC were diarrhea, nausea, fatigue/asthenia, neutropenia, decreased appetite, peripheral neuropathy (high-level term), vomiting, abdominal pain, constipation, and stomatitis. Duration of treatment in the pembrolizumab arm was almost double (median 11.1 months, range 0–30.6 months) than the duration of treatment in patients receiving SOC (median, 5.7 months). Approval of pembrolizumab is likely to change the treatment paradigm for first-line treatment with MSI-H advanced colorectal cancer given the study results and different safety profile.