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Cost-effectiveness acceptability curve presenting the probability that the nutritional intervention is cost-effective (y-axis) for weight increase, given various ceiling ratios for willingness to pay (x-axis)
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Hip fracture patients can benefit from nutritional supplementation during their recovery. Up to now, cost-effectiveness evaluation of nutritional intervention in these patients has not been performed. Costs of nutritional intervention are relatively low as compared with medical costs. Cost-effectiveness evaluation shows that nutritiona...
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Malnutrition is a common problem in critically ill patients in UK NHS critical care units. Early nutritional support is therefore recommended to address deficiencies in nutritional state and related disorders in metabolism. However, evidence is conflicting regarding the optimum route (parenteral or enteral) of delivery.
Objectives
To estimate the...
Citations
... It is not surprising that patients fall far short of the nutritional support needed to meet their increased energy demands. The incidence of malnutrition in hip fracture patients ranges from 6-78% in the orthopedic literature and is identified as the most financially costly co-morbidity associated with this patient group (15)(16)(17). ...
Background:
Orthopaedic trauma surgeons believe that nutritional status is important. The primary aim of this study was to prospectively investigate the prevalence and progression of malnourishment in orthopaedic trauma patients and determine when and what labs should be ordered. The secondary aim was to determine if malnourished patients had increased complications.
Methods:
Prospective cohort study of orthopaedic trauma patients at a Level I trauma center. Assessment of nutritional status over the hospital course was performed using the Rainey MacDonald nutritional index (RMNI) and nutritional laboratory markers on admission, day 3, day 7, and 6 weeks post-op.
Results:
98 patients were enrolled and included. On admission, 60%, 41%, and 38% of patients were malnourished based on albumin, prealbumin, and RMNI values, respectively, with 31% in severe acute-phase response (APR) as determined by CRP. By day 3, a significant increase in the percent of malnourished patients was noted based on the laboratory markers, 85%, 90%, and 80%, respectively, with 70% in severe APR. On day 7, values stabilized at 74%, 89%, 69%, with 56% in severe APR. At six weeks, malnourishment persisted in 13%, 19%, and 12% of patients, with 4% in severe APR. Older patients demonstrated a greater depression of nutritional markers throughout the hospital stay.
Conclusion:
The prevalence of malnourishment, based on serum nutritional markers, in the presence of acute orthopaedic injury is substantial, and it continues to rise during the acute hospital stay. Recommend obtaining prealbumin or albumin levels on hospital day 3 to assess nutritional status.
... [4][5][6][7] Clinical data further showed that perioperative nutrition supplements can shorten hospitalization duration of geriatric hip fracture patients. [8] Several clinical studies also demonstrated that geriatric hip fracture patients receiving perioperative nutrition supplement tend to have lower incidences of postoperative complications than those who receiving regular diets. [9][10][11] Notably, comparing with intravenous or nasogastric tube routes, oral nutrition supplements have been shown with the best cost-effectiveness in improving nutritional status of geriatric hip fracture patients. ...
... [9][10][11] Notably, comparing with intravenous or nasogastric tube routes, oral nutrition supplements have been shown with the best cost-effectiveness in improving nutritional status of geriatric hip fracture patients. [8] Clinical data further highlighted that protein is responsible for the beneficial effects of perioperative nutrition supplements. [12] In line with this notion, we conjectured that perioperative protein-based oral nutrition supplements may exert beneficial effects on improving postoperative outcomes in geriatric hip fracture patients. ...
... [10,11,21] This concept is confirmed by previous data that malnutrition increases the risks of having postoperative complications, having longer length of hospital stay and having in-hospital mortality in geriatric hip fracture patients. [4][5][6][7] Because protein-based oral nutrition supplements might exert beneficial effects on improving nutritional status of elderly hip fracture patients, [8] we thus hypothesized that geriatric hip fracture patients receiving preoperative protein-based oral nutrition supplements may have better postoperative outcomes. This hypothesis is partially confirmed by our data, as the metaanalysis data demonstrated that preoperative protein-based oral nutrition supplements could decrease the risk of having postoperative complications (up to an approximate 50% decrease) in geriatric hip fracture patients undergoing surgery. ...
Background:
Geriatric hip fracture patients often present malnutrition during admission, which leads to higher morbidity and mortality. Protein-based oral nutrition supplements may improve nutritional status. We conducted this systematic review and meta-analysis of randomized controlled trials (RCTs) according to the PRISMA guidelines to elucidate whether preoperative nutrition supplements can improve postoperative outcomes in geriatric hip fracture patients.
Methods:
Only RCTs conducted to compare postoperative outcomes between geriatric hip fracture patients (>60 years old) receiving preoperative oral protein-based nutrition supplement (ONS group) and those who receiving regular diet (Control group) were included. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception until August, 2021. Postoperative outcomes, including complications, length of hospital stay, and in-hospital mortality, were assessed.
Results:
A total of 5 RCTs with 654 geriatric hip fracture patients (ONS group: 320 subjects; Control group 334 subjects) were included. Our data revealed that postoperative complications risk in the ONS group was significantly lower than in the Control group (odd's ratio: 0.48, 95% confidence intervals [CI]: 0.26-0.89, P = .02, I2 = 64%). However, no significant differences in the length of hospital stay (standardized mean difference: -0.35 days, 95% CI: -1.68 to 0.98 days, P = .61, I2 = 0%) and the risk of having postoperative in-hospital mortality (odd's ratio: 1.07, 95% CI: 0.43-2.63, P = .89, I2 = 54%) between these 2 groups were observed. Quality assessment revealed high risk of bias and significant data heterogeneity (I2>50%) in most included RCTs.
Conclusion:
Preoperative protein-based oral nutrition supplements exert beneficial, but limited, effects on postoperative outcomes in geriatric patients with hip fracture undergoing surgery.
... However, we know little about its economic consequences, whose profile is often tied to the type of healthcare setting, nutritional intervention and patients' group [34]. Economic evaluations of ONS have been conducted in older malnourished hospitalized patients in the USA [35], the Netherlands [36] and Spain [37], admitted with benign gastrointestinal disease [38], hip fracture [39] or for lower gastrointestinal tract surgery [40]. ...
Objective
There is limited evidence regarding the economic effects of nutrition support in cancer patients. This study aims at investigating the cost-effectiveness profile of systematic oral nutritional supplementation (ONS) in head and neck cancer (HNC) patients undergoing radiotherapy (RT) and receiving nutritional counseling.
Methods
A cost-effectiveness analysis based on a RCT was performed to estimate direct medical costs, life years gained (LYG) and Quality-Adjusted Life Years (QALY) for nutritional counseling with or without ONS at 5-month and 6-year follow up time. Value of information analysis was performed to value the expected gain from reducing uncertainty through further data collection.
Results
ONS with nutritional counseling produced higher QALY than nutritional counseling alone (0.291 ± 0.087 vs 0.288 ± 0.087), however the difference was not significant (0.0027, P = 0.84). Mean costs were €987.60 vs €996.09, respectively in the treatment and control group (-€8.96, P = 0.98). The Incremental Cost Effectiveness Ratio (ICER) was -€3,277/QALY, with 55.4% probabilities of being cost-effective at a cost-effectiveness threshold of €30,000/QALY. The Expected Incremental Benefit was €95.16 and the Population Expected Value of Perfect Information was €8.6 million, implying that additional research is likely to be worthwhile. At a median 6-year follow up, the treatment group had a significantly better survival rate when adjusting for late effect (P = 0.039).
Conclusion
Our findings provide the first evidence to inform decisions about funding and reimbursement of ONS in combination with nutritional counseling in HNC patients undergoing RT. ONS may improve quality of cancer care at no additional costs, however further research on the cost-effectiveness of nutritional supplementation is recommended.
Trial Registration : ClinicalTrials.gov: NCT02055833. Registered 5th February 2014 https://clinicaltrials.gov/ct2/show/NCT02055833
... The remaining 215 articles underwent full-text screening, which resulted in a final list of 49 articles. Most studies were performed in Europe (44% (n = 24) [31][32][33]35,36,38,41,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63], of which 10 studies were in the UK. 33,35,41,49,53,55,56,58,59,61 Almost as many were performed in North America (n = 22 (42%) 26,28,30,34,39,40,[64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] ). ...
... For example, individual counseling was studied in both CEAs of malnourished populations 60,87 as well as CEAs of other populations. 78,82 In total, 34 studies had 1 or more arms that defined PN as "individualized" nutrition (arms: 46%, n = 45), followed by 18 studies 28,36,[39][40][41]45,47,48,50,54,56,58,60,63,72,75,77,84 that used "tailored" (arms: 23%, n = 23) and 18 studies 33,48,49,[52][53][54][55][56]58,61,62,67,68,72,73,77,81,86 that used "personalized" (arms: 19%, n = 20) (Fig. 2, Appendix 3 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2020.12.006). Ordovas et al 2 found that personalized nutrition partly overlaps with different terms such as individualized and tailored, but they have slightly different meanings; tailored interventions group individuals with shared characteristics, whereas personalized and individually tailored mean similar things and involve delivery of interventions suited to a particular individual. ...
... The societal perspective was most commonly used (n = 22 26,28,[30][31][32][33]36,49,50,52,54,56,58,60,63,65,68,71,74,81,82,86 ), followed by healthcare (n = 15 26,29,30,48,49,55,57,61,62,71,78,79,[86][87][88] ) and payer (n = 10 28,31,[39][40][41]45,47,50,73,75 ); other CEAs used a patient perspective (n = 2 28,76 ), intervention/program (n = 2 76,77 ), and employer (n = 1 65 ) (Fig. 2 68 was found. The smallest QALY gain was seen in the malnourished population (maximum:0.020 ...
Objectives
Important links between dietary patterns and diseases have been widely applied to establish nutrition interventions. However, knowledge about between-person heterogeneity regarding the benefits of nutrition intervention can be used to personalize the intervention and thereby improve health outcomes and efficiency. We performed a systematic review of cost-effectiveness analyses (CEAs) of interventions with a personalized nutrition (PN) component to assess their methodology and findings.
Methods
A systematic search (March 2019) was performed in 5 databases: EMBASE, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. CEAs involving interventions in adults with a PN component were included; CEAs focusing on clinical nutrition or undernutrition were excluded. The CHEERS checklist was used to assess the quality of CEAs.
Results
We identified 49 eligible studies among 1792 unique records. Substantial variation in methodology was found. Most studies (91%) focused only on psychological concepts of PN such as behavior and preferences. Thirty-four CEAs were trial-based, 13 were modeling studies, and 4 studies were both trial- and model-based. Thirty-two studies used quality-adjusted life-year as an outcome measure. Different time horizons, comparators, and modeling assumptions were applied, leading to differences in costs/quality-adjusted life-years. Twenty-eight CEAs (49%) concluded that the intervention was cost-effective, and 75% of the incremental cost-utility ratios were cost-effective given a willingness-to-pay threshold of $50 000 per quality-adjusted life-year.
Conclusions
Interventions with PN components are often evaluated using various types of models. However, most PN interventions have been considered cost-effective. More studies should examine the cost-effectiveness of PN interventions that combine psychological and biological concepts of personalization.
... 3, по мере увеличения продолжительности применения сипинга, дополняющего обычную диету, снижается количество осложнений в процессе реабилитации у пациентов с переломами шейки бедра, что обеспечивает отчетливый фармакоэкономический положительный результат (C. Wyers и соавт., 2013) [69]. ...
... По данным C. Wyers и соавт. (2010, 2013 г.), ПЭП, представляющее сбалансированные жидкие формулы и готовые к употреблению комбинации макро-, микро-и фармаконутриентов, оказывает положительное влияние на процесс реабилитации пациентов после проведенных в клинике травматологии и ортопедии лечебных мероприятий [69,72]. ...
The article provides an analytical review of the use of oral enteral nutrition (OEN, or sip feeding) as an adjuvant therapy and nutritional and metabolic support in various diseases and pathological conditions. Liquid and powdery sip feeds are currently becoming increasingly widespread due to their physiological nature and effectiveness in maintaining a nutritional status and eliminating nutritional deficiency in patients from different fields of medicine: oncology, musculoskeletal disorders, cardiovascular and pulmonary diseases (chronic obstructive pulmonary disease) and others. These sip mixtures contain proteins, fats, carbohydrates (macronutrients), omega-3 polyunsaturated fatty acids, as well as vitamins and minerals. Sip feeding is a supplement to a regular diet and is given between meals. The most prevalent sip feeding scheme is taking liquid forms of sip feeds in volumes of 200300 ml 23 times a day. Regimes which combine a regular diet and OEN should provide target indicators of energy and protein consumption: 2530 kcal/kg per day and 1.41.8 g of protein per 1 kg of body weight per day. In extremely severe cases, protein intake may be increased. Calorie ratio for individual nutrients in total energy consumption: proteins/fats/carbohydrates 20/30/50%. Sip feeding improves clinical and financial outcomes in inpatient and outpatient practice: shortens the time of staying in the clinic; reduces the number of infectious and non-infectious complications, the rate of repeated hospitalizations; treatment costs; improves the quality of life. OEN is recommended by the European Society for Clinical Nutrition and Metabolism guidelines and by many national guidelines on enteral nutritional support.
... 13,14,16 Poor nutritional status is also associated with increased mortality after hip fracture, may also negatively impact functional recovery. 17 Similarly, poor nutritional status at the time of fracture is found to be associated poor independent mobility 6 months after hip fracture. 18 Social support is another factor that affects recovery following hip fracture. ...
Background
Hip fractures are common with a UK incidence of over 70,000 cases and total healthcare costs of over £2 billion per year. Mortality rates of 10% at 30 days and up to 30% at 1-year have been reported. We wanted to assess the outcome of hip fracture surgery in patients with reduced pre-fracture mobility as this has not been exclusively studied previously.
Methods
We retrospectively reviewed 168 hip fracture patients with reduced pre-fracture mobility (wheelchair bound, bed bound, walking with 2 aids or a frame) who underwent hip fracture surgery at our institution between 2008 and 2013 using case notes, discharge letters, outpatient clinic letters and laboratory test results. Measured outcomes included 30-day renal, cardiac and respiratory morbidity as well as 30-day and 1-year mortality.
Results
Our study comprised 27% males and 73% females with a mean age of 82 years. The 30-day chest infection, acute renal failure and acute coronary syndrome rates were 26%, 7.7% and 4% respectively. In those patients who were either wheelchair or bed bound, 30-day and 1-year mortality rates were 11.8% and 52% respectively whereas in those who could mobilise with the help of 2 aids or frame, 30-day and 1-year mortality rates were 4.34% and 39.70% respectively.
Conclusion
Our study highlighted increased 30-day and 1-year morbidity and mortality rates following hip fracture surgery with notable high rates of respiratory and renal complications in patients with reduced pre-fracture mobility. We would recommend pre- and postoperative optimisation with orthogeriatric review, chest physiotherapy and intravenous fluid hydration to reduce complication rates and improve morbidity and mortality.
... The results of these studies seemed to be contradictive. Some studies found a beneficial effect on hospital stay [23,24], and postoperative complications [23][24][25][26], other studies failed to demonstrate so [27][28][29]. One explanation of the discrepancy might be the heterogeneity of included patients, baseline nutritional status, surgical procedures, and nutritional formula [22]. ...
Background:
Nearly half of elderly patients with hip fracture were malnourished, indicated with a serum marker of hypoalbuminemia. Malnutrition was a risk factor for poor outcomes in geriatrics after hip replacement. The purpose of this study was to investigate if oral nutritional supplementation after the procedure in geriatrics with hypoalbuminemia was beneficial for outcomes.
Methods:
A retrospective cohort study of older (≥ 65 years old) patients suffering femoral neck fracture and undergoing hip replacement with hypoalbuminemia was conducted. Outcomes were compared between patients with and without postoperative nutritional supplementation.
Results:
There were 306 geriatric patients met the criteria. Following adjustment for baseline characteristics, patients with nutritional supplementation showed a lower grade of wound effusion with adjusted OR 0.57 (95% confidence interval (CI), 0.36 to 0.91, P < 0.05). And also a lower rate of surgical site infection (5.5% compared with 13.0% [adjusted OR 0.40, 95% CI, 0.17 to 0.91, P < 0.05]), periprosthetic joint infection (2.8% compared with 9.9% [adjusted OR 0.26, 95% CI, 0.08 to 0.79, P < 0.05]), and 30 days readmission (2.1% compared with 8.7% [adjusted OR 0.22, 95% CI, 0.06 to 0.79, P < 0.05]). The average total hospital stay was longer in patients without nutritional supplementation (10.7 ± 2.0 compared with 9.2 ± 1.8 days, P < 0.05).
Conclusions:
The data suggest that postoperative nutritional supplementation is a protective factor for surgical site infection, periprosthetic joint infection, and 30-days readmission in geriatric with hypoalbuminemia undergoing a hip replacement. Postoperative nutritional supplementation for these patients should be recommended.
... The additional costs for nutritional intervention are as low as 3% of the total costs for hip-fracture care. 123 Based on the available evidence, dietetic assistants may be useful in increasing food and supplement intake, which can result in reduced mortality rates, but the results need to be validated in further randomized controlled trials. ...
Older people with hip fractures are often malnourished at the time of fracture, which can have substantial influence on mortality and clinical outcomes, as well as functional outcome and quality of life. A close relationship between protein intake and muscle maintenance has been demonstrated. Skeletal muscle weakness is an independent risk factor for falls and fall-related injuries in the elderly and is an independent marker of prognosis. However, the effect of perioperative nutritional interventions on outcomes in elderly hip-fracture patients remains controversial. In this narrative review, an overview is presented of the existing literature on nutritional status and sarcopenia in elderly hip-fracture patients, clinical outcomes, and the effects of nutritional intervention on outcome and rehabilitation in this patient group.
... Como se ha descrito la fractura de cadera conlleva una importante carga de enfermedad, asociándose a discapacidad física, disminución en la calidad de vida, muerte e incremento en la utilización de servicios de salud (12). Adicionalmente la presencia de algún grado de malnutrición se ha asociado a mayor alteración cognitiva, mayor dependencia funcional y es un factor independiente para morbilidad y mortalidad, mayor estancia hospitalaria, severidad de complicaciones agudas y limitación para la rehabilitación (13). El estado nutricional prefractura fue factor predictor para estado funcional al momento del alta independiente de otras comorbilidades, fuera de esto existe una asociación directa con peores tasas de recuperación (8). ...
Introducción:
las fracturas de cadera son una complicación frecuente y grave en las personas ancianas. Existen múltiples factores que se asocian con las fracturas de caderas en los ancianos, entre los que se destacan el estado nutricional y la funcionalidad de los afectados. El estado nutricional está condicionado en parte por el proceso de envejecimiento y por los cambios físicos, mentales, sociales y ambientales que se asocian a éste. La desnutrición es un problema de gran relevancia en la población anciana y que puede influir en el pronóstico asociado a diversos procesos patológicos. La presencia de alteraciones nutricionales se ha relacionado directamente con el estado funcional.
Objetivo:
determinar el estado funcional y nutricional previo, y su asociación en ancianos con fractura de cadera.
Material y métodos:
se estudiaron 177 ancianos con fractura de cadera del 1° enero de 2013 hasta el 31 de diciembre de 2016 que ingresaron al programa de ortogeriatría del Hospital Universitario San Ignacio en Bogotá, Colombia. A todos los pacientes se les analizó el estado funcional y nutricional dos semanas previo al evento. Se utilizó estadística descriptiva y análisis inferencial para pruebas de asociación con x2.
Resultados:
el 45.76% eran independientes para sus actividades básicas de la vida diaria y 54.23% presentaban algún grado de deterioro funcional. El 26.55% presentaban malnutrición, el 45.76% riesgo de malnutrición y 27.68% un estado nutricional adecuado. De los pacientes con algún grado de malnutrición (MNA<24), solo 32.81% eran independientes funcionalmente y 79.59% con adecuado estado nutricional eran independientes. La asociación entre malnutrición y dependencia funcional se estimó con un RP =3.94 (2.09-7.43 95% IC) con p=0.00.
Conclusión:
el estado nutricional y funcional son factores asociados a presentar fractura de cadera. (Acta Med Colomb 2019; 44: 7-10).
... Por ello, la valoración del estado nutricional es relevante en la medida en que la detección de los ancianos con riesgo de desnutrición permitiría actuar antes de que la desnutrición esté instaurada, reduciendo sus consecuencias y mejorando el estado de salud de los ancianos, así como su calidad de vida en general (7). No hay consenso en el método utilizado para valorar la desnutrición, de forma que se utiliza una herramienta diferente en cada ámbito (1,(8)(9)(10). ...
... Además, el coste del uso de suplementos nutricionales en el tratamiento de la desnutrición fue analizado en cinco artículos (9,16,21,22,26). Dos de ellos encontraron que el gasto por el tratamiento con suplementos nutricionales compensó económicamente con menos tiempo de hospitalización, mejora en el estado nutricional y menor gasto sanitario (22,26). ...
... La mayoría de los artículos seleccionados abordaron la DPE (1,14-24), que es la causa de complicaciones cuando se desarrollan otras enfermedades, y cómo la DRE contribuye al empeoramiento del estado nutricional (1,(8)(9)(10)(25)(26)(27)(28). En ambos tipos de desnutrición, su existencia supuso que la percepción de la calidad de vida de los ancianos desnutridos fuera negativa, considerándolo como una cuestión importante en sus vidas y una mayor demanda de recursos sanitarios al producirse un empeoramiento en la salud. ...
Introduction:
Background: there is a high number of dependent older adults with risk of malnutrition in the institutionalized geriatric population. Among others, the related factors are weight loss inherent to age, which favors frailty and sarcopenia, low body mass index (BMI) and the worsening of chronic diseases, which entails a deterioration in the quality of life. Objective: to analyze the relationship between dependence and nutritional status in elderly institutionalized people. Method: prospective observational and descriptive study in a sample of elderly institutionalized people. Dependence was studied by the Barthel index, sex, BMI, presence of chronic diseases and nutritional status with the Mini Nutritional Assessment (MNA). The association between the different variables was made with the Spearman correlation. Results: one hundred and sixty-four patients were included in the study; 45.10% (n = 74) of the patients had a total dependence and 18.30% (n = 30) had a moderate dependence. Women had a higher risk of total dependence than men (p < 0.0001). There was a significant relationship between the level of dependence and nutritional status, so that greater dependence increased the risk of malnutrition (p < 0.0001). Patients who were underweight had a greater risk of total dependence (RR 11.05 [95% CI 4.41, 27.7]). Patients with dementia were more dependent (p < 0.0001). Conclusion: most of the institutionalized elderly people presented some degree of dependence, which supposed a risk for the nutritional status that was aggravated if they suffered dementia and low weight.
