Economic evaluation of individualized nutritional support in medical inpatients: Secondary analysis of the EFFORT trial
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BACKGROUND & AIMS: Existing guidelines support the importance of nutritional interventions for medical inpatients at malnutrition risk to alleviate the impact of malnutrition on outcomes. While recent studies have reported positive effects of nutritional support on health outcomes, limited evidence exists on whether in-hospital nutritional support also results in economic advantages. We report the results of the economic evaluation of EFFORT-a pragmatic, investigator-initiated, open-label, multicenter trial. METHODS: A total of 2028 medical inpatients at nutritional risk were randomly assigned to receive individualized nutritional support to reach protein and energy goals (intervention group; n = 1015) or standard hospital food (control group; n = 1013). To calculate the economic impact of nutritional support, a Markov model was developed with relevant health states. Costs were estimated for days in normal hospital ward and in the Intensive Care Unit (ICU), hospital-acquired complications, and nutritional support. We used a Euro conversion rate of 0.93216 Euro for 1 Swiss Franc (CHF). RESULTS: The estimated per-patient cost was CHF90 (83.78 €) for the in-hospital nutritional support and CHF283.85 (264.23 €) when also considering dietitian consultation time. Overall costs of care within 30 days of admission averaged CHF29,263 (27,240 €) per-patient in the intervention group versus CHF29,477 (27,439 €) in the control group resulting in per-patient cost savings of CHF214 (199 €). Per-patient cost savings was CHF19.56 (18.21 €) when also accounting for dietician costs (full cost analysis). These cost savings were mainly due to reduced ICU length of stay and fewer complications. We also calculated costs to prevent adverse outcomes, which were CHF276 (256 €) for one severe complication, CHF2,675 (2490 €) for one day in ICU, and CHF7,975 (7423 €) for one death. For the full cost analysis, these numbers were CHF872 (811 €), CHF8,459 (7874 €) and CHF25,219 (23,475 €). Sensitivity analyses confirmed the original findings. CONCLUSIONS: Our evaluation demonstrates that in-hospital nutritional support for medical inpatients is a highly cost-effective intervention to reduce risks for ICU admissions and hospital-associated complications, while improving patient survival. The positive clinical and economic benefits of nutritional support in at-risk medical inpatients calls for comprehensive nutrition programs, including malnutrition screening, consultation, and nutritional support. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT02517476.
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In the EFFORT trial cost analysis, economic benefits calculated to prevent adverse outcomes were 256 € for one severe complication, 2490 € for one day in ICU, and 7423 € for one death.
“The economic benefits calculated to prevent adverse outcomes were 256 V for one severe complication, 2490 V for one day in ICU, and 7423 V for one death [46] (Level of Evidence 2þ).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [46]
Section 3.2 reports exactly €256 per severe complication prevented, €2,490 per ICU day prevented, and €7,423 per death prevented. It describes these figures as costs to prevent adverse outcomes, however, not economic benefits or savings from preventing them. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAn economic evaluation of EFFORT indicates that high-protein nutritional support was highly cost-effective with per-patient savings of 199 € of overall costs of care within 30 days of admission and 18 € in full cost analysis.
“An economic evaluation of EFFORT indicates that the high-protein nutritional support was highly cost-effective with per-patients savings of 199 V of overall costs of care within 30 days of admission; and 18 V in full cost analysis (Level of Evidence 1þþ) [46].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [46]
Section 3.2 reports savings of €199 per patient in the 30-day base-case analysis and €18.21 when dietitian costs were included; the summary calls the intervention highly cost-effective. But Section 2.3 describes individualized support aimed at both protein and energy goals, not a specifically high-protein intervention. (LLM, conf=0.87)
Experimental — accuracy not yet measuredCompared to usual care, individualized nutrition with protein targets of 1.2-1.5 g/kg/day in polymorbid patients was associated with significantly lower odds for adverse outcomes (OR 0.79, 95% CI 0.64 to 0.97) and 30-day mortality (OR 0.65, 95% CI 0.47 to 0.91), while functional status via BI and QoL significantly increased.
“Compared to the usual care CG, odds for adverse outcomes and 30-day mortality were significantly lower in patients receiving individualized nutrition with these protein targets (OR 0.79, 95% CI 0.64 to 0.97 and OR 0.65, 95% CI 0.47 to 0.91 respectively), while functional status via BI, and QoL significantly increased.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [46]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredPolymorbid medical inpatients requiring nutritional support shall receive 1.2-1.5 g protein/kg body weight per day as a cost-effective and highly efficient measure to prevent body weight loss, reduce complications, improve functional outcome and QoL.
“Polymorbid medical inpatients requiring nutritional support shall receive 1.2e1.5 g protein/kg of body weight per day as a costeffective and highly efficient measure to prevent body weight loss, to reduce complications, to improve functional outcome and QoL.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [46]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe cost analysis of the multicenter, randomized clinical EFFORT trial showed that nutritional support for polymorbid medical inpatients is a highly cost-effective intervention to reduce risks for ICU admissions and hospital-associated complications, while improving patient survival.
“The cost analysis of the multicenter, randomized clinical EFFORT trial showed that nutritional support for polymorbid medical inpatients is a highly cost-effective intervention to reduce risks for ICU admissions and hospital-associated complications, while improving patient survival.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [46]
In the EFFORT trial cost analysis, overall costs of care within 30 days of admission averaged 27,240 € per-patient in the intervention group versus 27,439 € in the control group, resulting in per-patient cost savings of 199 €.
“Overall costs of care within 30 days of admission averaged 27,240 V per-patient in the IG versus 27,439 V in the CG resulting in per-patient cost savings of 199 V.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [46]
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Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure
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“The economic bene fi ts calculated to prevent adverse outcomes were 256 V for one severe complication, 2490 V for one day in ICU, and 7423 V for one death [46] (Level of Evidence 2 þ ).”
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- Authors
- Schuetz, P., Sulo, S., Walzer, S., Vollmer, L., Stanga, Z., Gomes, F., Rueda, R., Mueller, B., & Partridge, J.
- Affiliations
- University of Basel (CH)
- Abbott (United States) (US)
- University of Applied Sciences Ravensburg-Weingarten (DE)
- University of Tübingen (DE)
- Kantonsspital Aarau (CH)
- Corresponding author
- Schuetz, Philipp
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 39
- Issue
- 11
- Pages
- 3361-3368
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2967649588
- Cited by
- 90
- References
- 5
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 16 · 2023: 13 · 2022: 10 · 2021: 20 · 2020: 4
- FWCI
- 7.42
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Nutrition (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Abbott Laboratories
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- individualized nutritional support, medical inpatients, malnutrition risk, cost-effectiveness, hospital food, dietitian consultation, ICU length of stay, hospital-acquired complications, cost reduction, Markov model, mortality costs
- MeSH terms
- Aged, Cost-Benefit Analysis, Female, Humans, Inpatients, Intensive Care Units, Length of Stay, Male, Markov Chains, Middle Aged, Treatment Outcome, Health Care Costs, Nutritional Support, Malnutrition, Precision Medicine
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