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

dc.contributor.author Sharma, Yogesh
dc.contributor.author Thompson, Campbell Henry
dc.contributor.author Miller, Michelle Deanne
dc.contributor.author Shahi, Rashmi
dc.contributor.author Hakendorf, Paul Haylett
dc.contributor.author Horwood, Chris
dc.contributor.author Kaambwa, Billingsley
dc.date.accessioned 2018-02-19T05:12:47Z
dc.date.available 2018-02-19T05:12:47Z
dc.date.issued 2018-02-05
dc.date.updated 2018-02-15T06:49:07Z
dc.description © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
dc.description.abstract Background Prevalence 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. Methods In 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). Results Nutrition 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. Conclusion This 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.
dc.identifier.citation Sharma, Y., Thompson, C., Miller, M., Shahi, R., Hakendorf, P., Horwood, C., & Kaambwa, B. (2018). Economic evaluation of an extended nutritional intervention in older Australian hospitalized patients: a randomized controlled trial. BMC Geriatrics, 18(1). https://doi.org/10.1186/s12877-018-0736-0
dc.identifier.doi https://doi.org/10.1186/s12877-018-0736-0
dc.identifier.uri https://doi.org/10.1186/s12877-018-0736-0
dc.identifier.uri http://hdl.handle.net/2328/37754
dc.language.iso en en
dc.publisher BioMed Central
dc.rights © The Author(s) 2018
dc.rights.holder The Author(s)
dc.rights.license CC-BY
dc.subject Malnutrition
dc.subject Economic evaluation
dc.subject Health related quality of life
dc.subject Quality adjusted life years
dc.subject Older patients
dc.title Economic evaluation of an extended nutritional intervention in older Australian hospitalized patients: a randomized controlled trial
dc.type Article en
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