Using CSN Reduced Costs

1.    Use of oral supplements in malnourished elderly patients living in the community: a pharmaco-economic study.

·      Study Design:

·      It was Observational, prospective, longitudinal, cohort study with 90 general practitioners in France.

·      The study population was 378 elderly malnourished patients aged over 70, living in the community, either at home or in institutions.

·      Duration of the study: 12 months follow-up

·      Intervention: Two groups of physicians were selected based on historical prescribing practice:

·      Group 1: with rare prescription of oral nutrition supplements.

·      Group 2:   with frequent prescription of oral nutrition supplements.

·      Measures:

·      Nutritional status at baseline was determined using the Mini Nutritional Assessment (MNA) scale.

·      Main outcome measures were nutritional status, malnutrition-related co morbidities, and medical care consumption.

·      Results:

·      After adjustment for baseline characteristics, MNA improved within both groups over time but improvement was significantly higher in group 2 than in group 1

·      The adjusted cost per patient of hospital care (EUR -551), nursing care (EUR -145) and other medical care was significantly reduced in group 2 as compared to group 1, with cost savings of EUR -723 per patient (90% CI: EUR -1.444 to EUR -43).

·      Including the costs related to nutritional products, the total cost savings per patient attributable to nutrition support were EUR -195 (90% CI: EUR -929 to EUR +478).

Appropriate nutrition support can address the problem of malnutrition among elderly individuals living in the community and may contribute to reduce the costs of health care.

Source: Arnaud-Battandier F, Malvy D, et al. Nestle Clinical Nutrition, Noisiel, France, INSERM U330, Université de Bordeaux, France. Clinical Nutrition, 2004 Oct;23(5):1096-103.   

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2.   Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition.

·    Study Design:

·    Prospective, controlled study has 298 older patients (>60 years) selected from the inpatient geriatric service of a university hospital (UMC Nijmegen) and a geriatric ward of a non-academic teaching hospital (Rijnstate Hospital, Arnhem).

·    For the study an interdisciplinary intervention was developed a protocol which includes screening for malnutrition, dysphasia and dehydration on admission, followed by immediate interventions

·    Study was to  assess effectiveness of the protocol on nutritional status, hospital-acquired infections and pressure sores, and to evaluate the protocol s economical feasibility

·    Intervention:

·    One of the geriatric wards applied the protocol (N=140)

·    The other provided standard care (N=158).

·    Measures:

·   Body mass was measured on admittance and discharge

·   Hospital-acquired infections and pressure sores were scored

·   Costs related to nutrition, infections and length of hospital stay were assessed.

·   Results:

·   There was a 0.8 kg loss (SEM 0.3 kg) in average weight in the standard care group and a 0.9 kg gain (SEM 0.2 kg) in the intervention group.

·   The number of hospital acquired infections was significantly lower in the intervention group (33/140 versus 58/158), but no significant difference in number of patients with pressure sores (23/140 versus 33/158) was found.

·   Costs were not significantly different: 7516 versus 7908 Euro/patient for intervention versus controls, respectively.

An early interdisciplinary intervention approach can be effective in reducing protein-energy malnutrition and related hospital-acquired infections and appears to be economically feasible

Source: Rypkema G, Adang E, et al Department of Geriatric Medicine, University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Journal of Nutrition, Health Aging. 2004; 8(2):122-7.

3.    Cost-effectiveness of Vitamin Therapy to Lower Plasma Homocysteine Levels for the Prevention of Coronary Heart Disease

Effect of Grain Fortification and Beyond

·    Study Design:

·    Cost-effectiveness analysis using the Coronary Heart Disease (CHD) Policy Model, a validated, state-transition model of CHD events in adults aged 35 through 84 years.

·    Data from the third National Health and Nutrition Examination Survey (NHANES III) were used to estimate age- and sex-specific differences in homocysteine levels.

·    Study was to examine the potential effect of grain fortification with folic acid on CHD events and to estimate the cost-effectiveness of additional vitamin supplementation (folic acid and cyanocobalamin) for CHD prevention.

·    Duration of the study: 10 years

·    Intervention:

·    A diet that includes enriched grain products projected to increase folic acid intake by 100 µg/d with the same diet without folic acid fortification.

·    A comparison between vitamin therapy that consists of 1 mg of folic acid and 0.5 mg of cyanocobalamin and the diet that includes grains fortified with folic acid.

·    Measures:

·    Incidence of myocardial infarction and death from CHD

·    Quality-adjusted life-years (QALYs) saved

·    Medical costs

·    Results:

·    Grain fortification with folic acid was predicted to decrease CHD events by 8% in women and 13% in men, with comparable reductions in CHD mortality.

·    The model projected that, compared with grain fortification alone, treating all patients with known CHD with folic acid and cyanocobalamin over a 10-year period would result in 310,000 fewer deaths, and lower costs.

·    Over the same 10-year period, providing vitamin supplementation in addition to grain fortification to all men aged 45 years or older without known CHD was projected to save more than 300 000 QALYs, to save more than US $2 billion, and to be the preferred strategy.

·    For women without CHD, the preferred vitamin supplementation strategy would be to treat all women older than 55 years, a strategy projected to save more than 140 000 QALYs over 10 years.

Folic acid and cyanocobalamin supplementation may be cost-effective among many population subgroups and could have a major epidemiologic benefit for primary and secondary prevention of CHD if ongoing clinical trials confirm that homocysteine-lowering therapy decreases CHD event rates

Source: Jeffrey A. Tice, MD; Elizabeth Ross, MD; Division of General Internal Medicine, Department of Medicine (Dr Tice), Department of Medicine (Drs L. Goldman and Coxson), University of California, San Francisco; Division of Clinical Nutrition (Drs Ross and Rosenberg) and General Internal Medicine (Dr Ross), Tufts University, Boston, Mass; Department of Health Policy and Management (Drs Hunink, Weinstein, Ms Goldman, and Mr Williams), Harvard School of Public Health, Boston, Mass; the Department of Epidemiology and Biostatistics and Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands (Dr Hunink). JAMA. 2001; No. 8, August 22, 286:936-943.