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Cited by 67Clinical Nutrition and GastroenterologyHealth Systems, Economic Evaluations, Quality of LifeEnhanced Recovery After Surgery

Cost savings associated with nutritional support in medical inpatients: an economic model based on data from a systematic review of randomised trials

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Schuetz, Philipp, Sulo, Suela, Walzer, Stefan, Vollmer, Lutz, Brunton, Cory, Kaegi-Braun, Nina, Stanga, Zeno, Mueller, Beat +1 more·2021·BMJ Open
DOI 10.1136/bmjopen-2020-046402PMC PMC8273448
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Abstract

Background and aims: Nutritional support improves clinical outcomes during hospitalisation as well as after discharge. Recently, a systematic review of 27 randomised, controlled trials showed that nutritional support was associated with lower rates of hospital readmissions and improved survival. In the present economic modelling study, we sought to determine whether in-hospital nutritional support would also return economic benefits. Methods: The current economic model applied cost estimates to the outcome results from our recent systematic review of hospitalised patients. In the underlying meta-analysis, a total of 27 trials (n=6803 patients) were included. To calculate the economic impact of nutritional support, a Markov model was developed using transitions between relevant health states. Costs were estimated accounting for length of stay in a general hospital ward, hospital-acquired infections, readmissions and nutritional support. Six-month mortality was also considered. The estimated daily per-patient cost for in-hospital nutrition was US$6.23. Results: Overall costs of care within the model timeframe of 6 months averaged US$63 227 per patient in the intervention group versus US$66 045 in the control group, which corresponds to per patient cost savings of US$2818. These cost savings were mainly due to reduced infection rate and shorter lengths of stay. We also calculated the costs to prevent a hospital-acquired infection and a non-elective readmission, that is, US$820 and US$733, respectively. The incremental cost per life-day gained was −US$1149 with 2.53 additional days. The sensitivity analyses for cost per quality-adjusted life day provided support for the original findings. Conclusions: For medical inpatients who are malnourished or at nutritional risk, our findings showed that in-hospital nutritional support is a cost-effective way to reduce risk for readmissions, lower the frequency of hospital-associated infections, and improve survival rates.

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  • For polymorbid medical inpatients who are malnourished or at nutritional risk, economic analysis using modelled cost-savings calculations of several RCTs reflect reductions in infectious complications, length of stay, and non-elective readmissions as measures for the effectiveness of in-hospital nutritional support.

    “For polymorbid medical inpatients who are malnourished or at nutritional risk, the economic analysis using modelled cost-savings calculations of several RCTs reflect reductions in infectious complications, LOS, and non-elective readmissions, as measures for the effectiveness of in-hospital nutritional support.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [47]

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  • The cost benefits in the Schuetz et al. meta-analysis were mostly due to reduced infection rates and shorter lengths of stay.

    “These cost benefits were mostly due to reduced infection rates and shorter lengths of stay.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [47]

  • In the meta-analysis of Schuetz et al., overall costs of care within the model timeframe of 6 months averaged 63,227 $ per patient in the intervention group vs 66,045 $ in the control group, corresponding to per patient cost savings of 2818 $.

    “In the metaanalysis of Schuetz et al. the overall costs of care within the model timeframe of 6 months averaged 63,227 $ per patient in the IG vs. 66,045 $ in the CG, which correlate to per patient cost savings of 2818 $.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [47]

  • The authors calculated 820 $ to prevent a hospital-acquired infection and 733 $ to avoid a non-elective readmission.

    “The authors also calculated 820 $ to prevent a hospital-acquired infection and 733 $ to avoid a nonelective readmission [47].”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [47]

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Authors
Schuetz, P., Sulo, S., Walzer, S., Vollmer, L., Brunton, C., Kaegi-Braun, N., Stanga, Z., Mueller, B., & Gomes, F.
Affiliations
  • Internal Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
  • Abbott Nutrition, Abbott Park, Illinois, USA
  • University of Applied Sciences Ravensburg-Weingarten (DE)
  • MArS Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany
  • Kantonsspital Aarau (CH)
  • University Hospital of Bern (CH)
  • New York Academy of Sciences (US)
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2021-07
Volume
11
Issue
7
Pages
e046402
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2020-046402
PMC
PMC8273448
OpenAlex
W3179079152
Cited by
67
References
6
Citations by year
2026: 14 · 2025: 21 · 2024: 10 · 2023: 12 · 2022: 10
FWCI
1.07
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Open Access CRIS of the University of Bern
Funders
Abbott Laboratories (N/A)
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 › Surgery › Enhanced Recovery After Surgery
Keywords
cost reduction, cost-effectiveness, hospital readmission, nosocomial infections, length of hospital stay, malnutrition, nutritional risk, medical inpatients, Markov model, quality-adjusted life years, survival
MeSH terms
Cost-Benefit Analysis, Humans, Inpatients, Randomized Controlled Trials as Topic, Cost Savings, Nutritional Support, Models, Economic

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