Economic evaluation of an extended nutritional intervention in older Australian hospitalized patients: a randomized controlled trial

Abstract

BackgroundPrevalence of malnutrition in older hospitalized patients is 30%. Malnutrition is associated with poor clinical outcomes in terms of high morbidity and mortality and is costly for hospitals. Extended nutrition interventions improve clinical outcomes but limited studies have investigated whether these interventions are cost-effective.MethodsIn this randomized controlled trial, 148 malnourished general medical patients ≥60 years were recruited and randomized to receive either an extended nutritional intervention or usual care. Nutrition intervention was individualized and started with 24 h of admission and was continued for 3 months post-discharge with a monthly telephone call whereas control patients received usual care. Nutrition status was confirmed by Patient generated subjective global assessment (PG-SGA) and health-related quality of life (HRQoL) was measured using EuroQoL 5D (EQ-5D-5 L) questionnaire at admission and at 3-months follow-up. A cost-effectiveness analysis was conducted for the primary outcome (incremental costs per unit improvement in PG-SGA) while a cost-utility analysis (CUA) was undertaken for the secondary outcome (incremental costs per quality adjusted life year (QALY) gained).ResultsNutrition status and HRQoL improved in intervention patients. Mean per included patient Australian Medicare costs were lower in intervention group compared to control arm (by $907) but these differences were not statistically significant (95% CI: -$2956 to $4854). The main drivers of higher costs in the control group were higher inpatient ($13,882 versus $13,134) and drug ($838 versus $601) costs. After adjusting outcomes for baseline differences and repeated measures, the intervention was more effective than the control with patients in this arm reporting QALYs gained that were higher by 0.0050 QALYs gained per patient (95% CI: -0.0079 to 0.0199). The probability of the intervention being cost-effective at willingness to pay values as low as $1000 per unit improvement in PG-SGA was > 98% while it was 78% at a willingness to pay $50,000 per QALY gained.ConclusionThis health economic analysis suggests that the use of extended nutritional intervention in older general medical patients is likely to be cost-effective in the Australian health care setting in terms of both primary and secondary outcomes.Trial registrationACTRN No. 12614000833662. Registered 6 August 2014.

High prevalence of malnutrition and nutrition impact symptoms in older patients with cancer: Results of a Brazilian multicenter study

“…However, of these instruments, the PG–SGA is considered a reference tool in patients with cancer . Moreover, the PG–SGA addresses the highest number of NIS, which can be considered risk factors for malnutrition, such as no appetite, nausea, vomiting, problems swallowing, and other NIS . Identifying the causes of problems with eating (using box 3 on the PG–SGA questionnaire) may facilitate the early prevention or treatment of those impediments, which, in the end, may help prevent malnutrition, or at least prevent the symptoms from getting worse.…”

“…Identifying the causes of problems with eating (using box 3 on the PG–SGA questionnaire) may facilitate the early prevention or treatment of those impediments, which, in the end, may help prevent malnutrition, or at least prevent the symptoms from getting worse. Therefore, these NIS need to be monitored to avoid unfavorable clinical outcomes in patients of all ages and with the progression of age …”

“…30 Moreover, the PG-SGA addresses the highest number of NIS, which can be considered risk factors for malnutrition, such as no appetite, nausea, vomiting, problems swallowing, and other NIS. 18,30,48,49 Identifying the causes of problems with eating (using box 3 on the PG-SGA questionnaire) may facilitate the early prevention or treatment of those impediments, which, in the end, may help prevent malnutrition, or at least prevent the symptoms from getting worse. Therefore, these NIS need to be monitored to avoid unfavorable clinical outcomes in patients of all ages and with the progression of age.…”

“…Therefore, these NIS need to be monitored to avoid unfavorable clinical outcomes in patients of all ages and with the progression of age. 49 The strengths of the study include the large sample size and that the sample was represented by patients from various regions of Brazil. The limitations of this study are the absence of data on cancer stage, type of treatment, and changes in the prevalence of NIS over time, which is inherent to the cross-sectional study design.…”

The Movember Prostate Cancer Landscape Analysis: an assessment of unmet research needs

“…Research in the field that could enable significant improvement in the research need, if Movember were to support it Five publications were ultimately deemed to be the most relevant to the needs of men with prostate cancer [8][9][10][11][12] . Two approaches were identified regarding how to develop the prioritization criteria.…”