Healthcare Costs Matter: a review of nutrition economics - Is there a role for nutritional support to reduce the cost of medical healthcare?
Jane K Naberhuis, Vivienne Hunt*, Jvawnna Bell, Jamie Partridge, Scott Goates and Mark Nuijten
*Corresponding author Dr Vivienne Hunt Vivienne.firstname.lastname@example.org
Nutrition and Dietary Supplements 2017:9 1-8 Dovepress. Download paper at www.dovepress.com - open access to scientific and medical research.
Key message :
This paper highlights that providing nutritional support can reduce medical health care costs. The review identities a growing interest in research on the economics of providing nutrition interventions to improve health and reduce medical spend. As populations age, understanding this link between nutrition and its ability to improve health while saving health care expenditure will become critical.
Background & Aims: As policy-makers assess the value of money spent on healthcare, research in the field of health economics is expanding rapidly. This review characterizes the publication of papers at the intersection of health economics and nutrition.
Methods: Relevant publications on nutrition care were identified in medical literature databases using predetermined search criteria which included nutritional and health economic terms. Inclusion criteria required an original research study with clinical outcomes and cost analyses, subjects’ ages ≥ 18 years, and publication in English between January 2004 and October 2014.
Results: Of 5,646 publications identified in first-round searches, 274 met the inclusion criteria. The number of publications on nutrition economics has increased markedly over the ten year period, with a growing number of studies in both developed and developing countries. Most studies were undertaken in Europe (39%) and the United States and Canada (28%). The most common study setting was the hospital (62%) followed by community/non-institutional care (30%). Of all studies, 12% involved the use of oral nutritional supplements, and 13% involved parenteral nutrition. Commonly measured variables were medical care costs (53% of studies), hospital length of stay (48%), hospital readmissions rates (9%), and mortality (25%).
Conclusions: The number of publications focused on the economics of nutrition interventions has increased dramatically in recent years. Studies have demonstrated that malnutrition can increase the costs of care and length of hospital stay while corresponding studies show that nutrition interventions can help lower the cost of healthcare by decreasing the incidence of complications and speeding recovery. As populations’ age, policies that lead to wider adoption of screening, assessment and treatment of malnutrition will be important to improve health economic outcomes.
Keywords: malnutrition prevention, economics of nutrition interventions, cost effective medical care
Childhood Stunting, Wasting and Obesity in Indonesia: Evidence from the Indonesian Family Life Survey
Rhema Vaithianathan, Auckland University of Technology, Singapore Management University Nan Jiang, Auckland University of Technology
Abstract: Several studies have reported high prevalence of malnutrition in children under 5 years old in Indonesia (Agho, Kingsley E., et al. 2009; Grantham-McGregor, Sally, et al. 2007). At the same time, Indonesia is experiencing an increase in its rate of obesity. In these environments, policy makers may well be worried that in this sort of environment, strategies aimed at reducing one problem might exacerbate the other. For example, when supplementary feeding is poorly targeted, obesity rates might rise. This paper evaluates the Indonesian Program Makanan Tambahan (PMT) which provided nutritional supplementation to infants and young children and asks whether those children receiving the program experienced higher obesity rates than those who did not. This program is a good one to look at, because a previous study (Giles and Satriawan, 2015) showed that the PMT had some impact on reducing stunting amongst those children who had higher rates of exposure to the program. We use the same data set, the Indonesian Family Life Survey (IFLS) and the same quasi-experimental methodology to test whether exposure increased overweight (BMIAZ>2). The baseline rates of stunting (HAZ<-3) in children under five in this data was 13%. The rates of overweight were 7.8%. Using our data we first confirmed that the children with higher exposure had lower stunting rates. We further found that treated children and untreated children had the same rates of over-weight. We conclude that the PMT program had no effect on overweight risk but had beneficial effects on reducing stunting. Using Giles and Satriawan’s estimates of impact, we estimate that if PMT was offered to all Indonesian children, it would remove 864,000 children from severe stunting, and using Hoddintott’s (2013) method, release $1-$5b in GDP through increased productivity of the un-stunted children.
POSTER PRESENTATION at the ISPOR 7th Asia-Pacific Conference to be held 3-6 September 2016 at the Suntec Singapore Convention & Exhibition Center, Singapore:
The clinical and economic impact of the use of diabetes-specific enteral formula on ICU patients with type 2 diabetes
Background & Aims: Patients admitted to intensive care units (ICUs) often need enteral nutrition (EN) support. For patients with type 2 diabetes (T2D), standard EN formulas may not provide ideal nutrients. The purpose was to investigate whether use of a diabetes-specific formula (DSF) could provide clinical and health economic benefits (compared to standard formulas) in critically ill patients with T2D.
Methods: This study was a retrospective analysis of medical records and expenditure data covering a 5-year period (2009-2013) from the hospitalization database of the National Taiwan University Hospital. Records of ICU patients who had T2D and were receiving enteral feeding with either the DSF or non-diabetes-specific formula (non-DSF) for at least 5 days were included in the analysis. Mortality, ICU length of stay (LOS), diabetes-related medications, and total costs of care (including all costs covered by the National Health Insurance and private expenses) were considered as the primary outcomes.
Results: A total of 158 patient records were analyzed in the DSF group and 794 in the non-DSF group. The baseline demographics including age, gender, weight, body mass index (BMI), and comorbidity patterns were mostly comparable between the groups. Compared to those receiving non-DSF, patients with T2D receiving DSF were found to have significantly decreased mortality (5.1% vs. 12.3%, P=0.0118) and reduced need for insulin prescription (29.1% vs. 38.4%, P=0.0269). ICU LOS was shorter for DSF patients, but no statistical difference was found (13.0 days vs. 15.1 days, P=0.1843). However, significantly lower total ICU costs were reported for DSF patients (6,700 USD vs. 9,200 USD, P<0.0001).
Conclusions: The use of DSF in ICU patients with T2D is correlated with significant reduction in mortality and improved health economic outcomes.