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

Abstract

Malnutrition, particularly under-nutrition, is highly prevalent among adult patients with a diagnosis of gastrointestinal (GI) cancer and negatively affects patient outcomes. Malnutrition is associated with clinical and surgical complications for patients undergoing therapy for GI cancers and the costs associated with those complications is a high burden for the US health system. Our objective was to identify high-quality evidence for nutrition support interventions associated with cost savings for patient care, followed by a complex economic value analysis to project cost savings for the US health system. A narrative literature search was conducted in which combined keywords in the areas of therapeutic nutrition (nutrition, malnutrition), a specific therapeutic area [GI cancer (esophageal, gastric, gallbladder, pancreatic, liver/hepatic, small and large intestine, colorectal)], and clinical outcomes and healthcare cost, to look for nutrition interventions that could significantly improve clinical outcomes. Medicare claims data were then analyzed using the findings of these identified studies and this modeling exercise supported identifying the cost and healthcare resource utilization implications of specific populations to determine the impact of nutrition support on reducing these costs as reflected in the summary of the evidence. Eight studies were found that provided clinical outcomes and health cost savings data, 2 of those had the strongest level of evidence and were used for Value Analysis calculations. Nutrition interventions such as oral diet modifications, enteral nutrition (EN) supplementation, and parenteral nutrition (PN) have been studied especially in the peri-operative setting. Specifically, peri-operative immunonutrition administration and utilization of enhanced recovery pathways after surgery have been associated with significant improvement in postoperative complications and decreased length of hospital stay (LOS). Utilizing economic modeling of Medicare claims data from GI cancer patients, potential annual cost savings of $242 million were projected by the widespread adoption of these interventions. Clinical outcomes can be improved with the use of nutrition interventions in patients with GI cancers. Healthcare costs can be reduced as a result of fewer in-hospital complications and shorter lengths of hospital stay. The application of nutrition intervention provides a positive clinical and economic value proposition to the healthcare system for patients with GI cancers

Cost-Effectiveness of the Use of Acerto Protocol in Major Digestive Surgery

“…Pimento et al have recently reported that healthcare costs can be reduced by the implementation of nutrition intervention for patients with gastrointestinal cancers 17 . We agree with that, since the implementation of the ACERTO project changed the nutritional approach in our patients from a staff-oriented perspective to a protocol-oriented protocol, which was absorbed by the multidisciplinary staff of the hospital including not only surgeons but also nurses, dietitians, and physiotherapists.…”

The Diet as a Modulator of Tumor Microenvironment in Colorectal Cancer Patients

“…Perioperative immunonutrition and recovery strategies after surgery have significantly decreased postoperative complications and decreased hospital stays. Savings due to the adoption of these measures have been estimated at more than 200 million dollars [ 130 ].…”

Nutrition care is an integral part of patient-centred medical care: a European consensus

“…In the UK, it was found that the cost of treating a malnourished patient is up to 3 times higher compared to a non-malnourished patient [112] Data from the Netherlands reveal that managing disease-related malnutrition accounted for 4.9% of total healthcare expenditure [118]. US economic modelling based on international health economics data suggested that widely implementing nutrition support in gastrointestinal cancer alone could account for up to US $242 million in Medicare savings each year [119]. Importantly, these savings have been demonstrated in real-world settings, showing that significant cost savings can be achieved by implementing optimal nutrition care in cancer [114,115,120].…”