Managing Academic Collaborations to Improve Health Outcomes
 

PROJECTS MANAGED IN ASIA AND NEW ZEALAND

 
 

The Role of Nutrition to Reduce Medical Care Costs

 

Project Description

We commissioned a post-doctoral student at the University of Illinois Urbana Champaign to conduct a systematic review of studies that demonstrated a link between nutritional support and improved health economic outcomes. After analysis of the studies that met the inclusion criteria covering a ten-year period we wrote up the findings to identify research gaps and suggest future work. Our aim was to build the scientific evidence that demonstrates how nutritional interventions can to reduce medical care costs and improve health outcomes.

Why do this Project?

There is a growing body of research demonstrating that nutritional interventions can both improve the health outcomes for a patient and lead to reduced medical care expenditure. Health economists are using a variety of tools to quantitatively measure the economic benefits of such interventions. We wanted to assess the types of studies conducted to support work that our company was doing in nutrition economics. We wanted to evaluate studies demonstrating how nutritional interventions can provide support for better health and whether these were cost effective.

Why is this Important?

Research shows malnutrition in hospitals can range from 20 – 50% (see graph below). This is worse among the elderly and even occurs in developed countries like Singapore and the Netherlands.  Often at discharge from hospital, the data shows some patient’s nutritional state has worsened considerably during their hospital stay. A simple nutritional intervention like supplementation can help provide additional health benefits at low cost. This review sought to measure such interventions in terms of cost and outcomes.

The Consequences of Malnutrition

There is strong evidence that malnutrition can cause a range of negative health and economic outcomes. They are listed below (table):

 
 
 
 

*QALY Quality Adjusted Life Year is a generic measure of disease burden includes both the quality and quantity of life lived it is used in economic evaluation of medical interventions to assess the value for money. One QALY equates to one year lived in good health.

 
 

Findings

The review showed that there is growing interest in implementing and measuring the effect of a health intervention based on nutritional support. The number of publications focused on the economics of nutritional interventions has increased significantly with studies demonstrating that a range of economic assessments are being used to measure the cost effectiveness of the interventions1

 
 

Key Message

As populations age, policies need to encourage wider adoption of screening, assessment and treatment of malnutrition to improve health and economic outcomes. Research needs to find sustainable health solutions based on nutrition.

Publication link to pdf

References

  1. Health Care Costs Matters: A Review of Nutrition Economics - is there a role for nutritional support to reduce the cost of medical health care? JK Naberhuis, VN Hunt, JD Bell, JS Partridge, S Coates and MJC Nuijten, Nutrition and Dietary Supplements 2017:9 1-8
  2. Whitehead, SJ Ali S Health Outcomes in Economic Evaluation: The QALY and Utilities Br Med Bulletin 2010;96 (1): 5-21     

 

 
 
 

The Impact of Nutrition Supplementation on Stunting


What is Stunting?

Stunting is a result of stunted growth that reflects failure to reach linear growth potential as a result of suboptimal health and/or nutritional conditions. It is typically measured by Z scores (standard deviations from the mean) as low height-for-age stunting or low weight-for-height (wasted). Visit WHO website for more information.

Project Description

This project used survey data to quantitatively assess the effectiveness of a Govt. supplementation programme initiated in Indonesia during the financial crisis of 1998. Working with publicly available data researchers in Indonesia worked with our health economists to track the effect of this supplementation which was targeted at vulnerable households. The economists measured its impact on stunting prevalence rates in Indonesia pre-and post supplementation.3

Why do this Project?

We initiated this project to highlight to the Government and healthcare stakeholders the prevalence of stunting among children in parts of Southeast Asia (Indonesia). We wanted to evaluate the long-term impact of stunting and its effect on economic productivity and to assess the size of this impact on Indonesia.  

Why is this Important?

Research has demonstrated that being stunted height for weight has a long-term effect where the child who is stunted does not develop sufficiently to reach his or her full earning potential as an adult. Our paper drew on the work of others to show that supplementing vulnerable children did lead to improved earnings as adults.1 Indonesia is suffering from a double burden of under-nutrition and over-nutrition. The growing affluence and adoption of new diets is linked to obesity in children and adults but a large proportion of the population is still facing under -nutrition. Measuring the economic impact of undernutrition can inform health policy.

Research Findings

Using the research findings from other studies our health economists estimated the economic impact of stunting in Indonesia. Using pre-published data, they calculated if severe stunting alone was eliminated it could release $1-$5b in GDP through increased productivity of the un-stunted children. The increase in economic output would result from children achieving optimal growth and realizing their human capital as adults.

Key Message

The key message of this analysis is that many developing countries, not just Indonesia face a double burden of under and over-nutrition. Our analysis suggests that if health care providers could reduce stunting rates by focussing those severely stunted, the Indonesian economy could realise increased productivity.

Stunting is measure of equality which must be addressed through education, good nutrition and equitable access to health and finance. Ensuring vulnerable populations have nutrition at critical stages of their development can play a critical role in addressing such inequality and its lifetime trajectory.
 

References

  1. Hoddinott, J., Maluccio, J., Behrman, Rafael Flores, Reynaldo Martorell (2008) Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults/ www.thelancet.com Vol. 371 February 2, 2008 Accessed July 23, 2015
  2. Vaithianathan, R Jiang, N Childhood Stunting, Wasting and Obesity in Indonesia: Evidence from the Indonesian Family Life Survey. Poster presented ISPOR, Sept 2016 Singapore by Vivienne Hunt
  3. Vaithianathan, R and Jiang N (2016) Childhood Stunting, Wasting and Obesity in Indonesia: Evidence from the Indonesian Family Life Survey November 2016 Published Value in Health, ISPOR Journal Volume 19, Issue 7, Page A881

 

 

Effect of Specialised Nutrition on Diabetes Control in Taiwan

 

Project Description

This project was designed to demonstrate how specialised nutrition designed for diabetes could reduce time spent in the Intensive Care Unit (ICU). While there is a large body of work showing the positive effect of specialised diabetic nutrition to manage glycaemic control and reduce mortality rates in hospitals, few studies are based on Asian data. Working with a hospital in Taiwan we analysed hospital patient records to measure the impact of Diabetic specific Oral Nutritional Supplements on outcomes in the ICU.

Why do this Project?

Diabetes is the 10th leading cause of death globally. In Australia 1.7 per cent of total deaths in 2011 with the major type of diabetes being Type 2. The statistics show that most to those suffering from diabetics are over 40.

Diabetes Creates a Significant Economic Burden on Health Care Systems In 2007, the cost of diabetes was estimated at $174 billion, with $116 billion attributed to excess medical expenditures and 50% being spent on inpatient care.1

In Singapore MOH data suggests one in three is diagnosed with diabetes one in three is undiagnosed.2

In 2012, the cost of diabetes in the US was calculated by the American Diabetes Association to have increased 41% to $245 billion with $176 billion direct costs and $69 billion due to reduced productivity.3

Some of the Indirect Economic Outcomes of Diabetes

American Diabetes Association,2007 analysis of the indirect costs of diabetes:

  • 6 million days of reduced productivity for those not in the workforce,
  • 15 million work days due to absenteeism
  • 107 million workdays lost due to unemployment disability due to diabetes (445,000 cases of unemployment disability in the US) 2
  • 120 million work days with reduced performance

Why is Management of Diabetes Important?

Diabetes management is all about control of glycaemia (presence of glucose in the blood). The A1C test is a blood test that provides information about a person’s average levels of blood glucose. The A1C test is the primary test used for diabetes management and diabetes research. A percentage point drop in A1C can reduce the risk of microvascular complications by up to 40% (CDC, 2011). The figures below show some of the effect of poorly managed diabetes.

 
 
Figure 1 Neuropathy caused by Diabetes

Figure 1 Neuropathy caused by Diabetes

Figure 2: Diabetes caused Retinopathy

Figure 2: Diabetes caused Retinopathy

Figure 3 Diabetes Affects the Kidney

Figure 3 Diabetes Affects the Kidney

 
 

Key Findings

Using data collected over a 5 years’ period (2009-2013) from the National Taiwan University Hospital, our researchers analyzed the link between receiving specialized diabetic specific nutrition and the health economic outcomes. They found that those who received diabetic nutrition supplementation had reduced time in the ICU, lower medical care costs and reduced rates of mortality.

Key Message

The evidence based on the 5-year data analyzed suggests that not only does Diabetic Specific Nutrition lead to lower costs of medical care through less time in the ICU with a reduced medical spend but it can lead to reduced mortality rates amongst patients admitted to the ICU with diabetes. 

References

  1. American Diabetes Association. Economic costs of diabetes in the US in 2007. Diabetes Care.2008;31(3):596–615.
  2. MOH reference (get)
  3. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care 2013; 36:1033–1046
  4. American Diabetes Association. Direct and indirect costs of diabetes in the United States.
  5. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html. Accessed April 7, 2009.
 
 

Corporate Wellness Project - Diabetes and a Lifestyle Invention in Delhi Workplaces

 

Project Description

Working together with another MNC this project sought to understand more about the role of a lifestyle intervention to reduce the risk of diabetes in those not yet diagnosed as diabetics. The intervention included a digital health platform that could be used to engage with participants to keep them motivated and following a programme over a 6-month period in New Delhi workplaces. They would follow an exercise programme, have nutrition education and engage with health care practitioners for one on one counselling during the intervention. The stakeholders included in this project were Indian health care institutions, two MNCs, Government WHO policy advisers, catering companies, gymnasium and health companies as well as leading academics who specialised in diabetes in India.

Why do this Project?

We were looking for employer led interventions that could be introduced in India. The key was that they needed to be sustainable and relatively low cost. Our target participants were those who were overweight and at risk of diabetes. In the urban settings of India, changing food patterns and more sedentary work has led to higher rates of obesity. A nationwide (India) survey revealed that about 10-16% population of urban area is diabetic1

Findings

A digital platform was developed to provide an interactive tool through which to engage with participants enrolled in the pilot. A multi component life style intervention was initiated at four employer sites in New Delhi with two acting as controls. The platform encouraged participants to provide input on how they were following the programme and form social groups to challenge and support each other.

After the 6 months of intervention followed by 3 months maintenance, the results were encouraging. There was significant positive change in the biomarkers associated with diabetes, obesity and reduced cardio-metabolic risk factors in the intervention group compared with the control group. The most important finding was a 50% reduction in the pre-diabetes population post intervention in addition to a reduction of 0.2 % Hb1Ac

Key Message

The study indicates that through this intervention, there is a high probability of preventing pre-diabetes from progressing to diabetes and that the intervention programme can restore a normal glucose metabolism. This suggests that the intervention has the potential to improve productivity, quality of life and reduce the economic burden of future medical treatment. Govt and WHO stakeholders were excited about this potential for this pilot to be scaled up for implementation across workplaces in India.

Workplace coaching sessions in New Delhi

References

  1. Kaveeshar and Cornwall, 2014 (2014) The Current State of Diabetes Mellitus in India, Australia Med Journal.  7(1): 45–48.
 
 

Nutritional Health in the Elderly in Singapore

 


Project Description

This project was initiated as a result of exploring local data on frailty and malnutrition amongst the elderly in Singapore. We were shocked to find malnutrition prevalence rates of over 30% in those over 65. These were associated with long periods of stay in hospital. Working with an innovation oriented health care centre in Singapore we developed a programme of research to understand the unique needs of Asian populations in the Singapore context. In partnership with the regional health care centre we developed a proposal for Govt funding to  be successfully funded for a national programme of work to drive our understanding of nutritional needs of elderly Singaporeans.

Why do this Project?

The data suggests the poor nutritional status amongst the elderly is a strong predictor for increased frailty, falls and fractures as well as a suppressed immune system. All of these can lead to emergency admissions to hospital with the associated costs to the health care system. Singapore has the second fastest ageing population in the world (next to Japan). The Government is supporting a number of healthy ageing initiatives. The anecdotal evidence suggests that the elderly increasingly live alone, do not consume dairy and often have inadequate protein in their diets. We wanted to learn about the type of protein based supplements such participants would agree to take.

Findings

This project is still ongoing with several research strands including a clinical trial providing an oral nutritional supplement as well as developing new product prototypes to seek sensory feedback from participants. The research will inform the design of products to meet the cultural needs and taste preferences of Asian populations. With Singapore having Chinese, Malay and India subcultures the findings will assist with product development in Southeast Asia. The project will develop a predictive risk tool using data from the community and hospital settings to identify those at risk of malnutrition so that early interventions can be made.

 
 
 
 

Oral and Traditional History Project with Te Waimate Taiamai Alliance


Project Description and Objectives

The objective of this project was to collect, clarify and present the oral history in a technical report supporting research from written collections regarding the Te Waimate/Taiamai areas of Northland. The Mira Szászy Research Centre at The University of Auckland, was commissioned to present evidence to support claims to support claims to be made before the Waitangi Tribunal on behalf of claimant groups of Ngā Puhi, North Auckland. This work followed a technical report prepared for claimant groups of Ngā Puhi, North Auckland. “He Whenua Rangatira” Northern Tribal Landscape Overview (Hokianga, Whangaroa, Bay of Islands, Whāngārei, Mahurangi and Gulf Islands). The purpose of the Tribal Landscape Overview was to consider to consider patterns of occupation, right-holding and hapū/iwi relationships and interaction in these districts in the Nineteenth Century. Final report was 760pp.

Findings

The process of managing these projects involved many huis (gatherings) to discuss findings and inform other hapu (sub tribes) within the iwi.1 We needed to work inclusively but work within the timelines to ensure the 511-page report was complete and covered all the material

Key Learnings

Settlement of the Treaty of Waitangi claims has been an ongoing process for years. While some claims are still under review, the process of gathering data from oral and traditional histories was informative and challenging. Managing the milestones leading to the compilation of this important report and being part of the engagement process, I learned much about northern Maori economic history and development and partnership with Maori. 265 words

References

  1. Hapu is kinship group, clan, tribe, subtribe - section of a large kinship group and the primary political unit in traditional Māori society. A number of related hapū usually shared adjacent territories forming a looser tribal federation (iwi).  
  2. Accessed Maori Dictionary 25 May 2017
 
 
 

Measuring the Innovation Index of New Zealand
 

Project Description and Objectives

This project sponsored by IBM sought to measure the level of innovation in New Zealand across 18 sectors of business. With a team of economists, IP lawyers and other innovation experts the output was an Innovation Index which was a comprehensive, multi-indicator benchmarking study showing the shape and rate of innovation across "the selected industries" between 2007 and 2011 in New Zealand. The overall Index is a weighted composite of three broad official measures of innovation; R&D, Intellectual Property and Business Innovation.  New Zealand was ranked 17th in the 2016 Global Innovation Index (see link below). While we are behind Singapore at 6th place, we punch well above our weight in terms of innovation outputs and efficiency ratios.

For more information visit https://www.globalinnovationindex.org/

 
 
 

Food and Health Research at The University of Auckland


Project Description and Objectives

The Food and Health programme is an interdisciplinary research and teaching programme drawing on specialist expertise in food science, process engineering, nutrition, health, social sciences, business and commercialisation from across the University of Auckland.

Initiated in 2009, I was responsible for industry engagement working with Dean of Science and other faculty members to launch the programme to a network of potential partners. This included show casing the work of leading academics, facilitating innovation workshops to develop shared research agendas with industry partners and winning new research contracts.

Outcomes

A key objective of the programme was to bring together different disciplines to work on research that could add value to food exports.  The programme started with around 80 academics and now involves 200 academics. Initially the programme focussed on research and role of food to improve health conditions. Since then many more initiatives have been developed – for more information click here.