Economic burden of hospital malnutrition and the cost–benefit of supplemental parenteral nutrition in critically ill patients in Latin America

Abstract

Aim: Disease-related malnutrition (DRM) is a prevalent condition that significantly increases the risk of adverse outcomes in hospitalized patients, particularly those with critical illness. Limited data is available on the economic burden of DRM and the cost–benefit of nutrition therapy in high-risk populations in Latin America. The aims of the present study were to estimate the economic burden of DRM and evaluate the cost–benefit of supplemental parenteral nutrition (SPN) in critically ill patients who fail to receive adequate nutrient intake from enteral nutrition (EN) in Latin America.

Methods: Country-specific cost and prevalence data from eight Latin American countries and clinical data from studies evaluating outcomes in patients with DRM were used to estimate the costs associated with DRM in public hospitals. A deterministic decision model based on clinical outcomes from a randomized controlled study and country-specific cost data were developed to examine the cost–benefit of administering SPN to critically ill adults who fail to reach ≥60% of the calculated energy target with EN.

Results: The estimated annual economic burden of DRM in public hospitals in Latin America is $10.19 billion (range, $8.44 billion–$11.72 billion). Critically ill patients account for a disproportionate share of the costs, with a 6.5-fold higher average cost per patient compared with those in the ward ($5488.35 vs. $839.76). Model-derived estimates for clinical outcomes and resource utilization showed that administration of SPN to critically ill patients who fail to receive the targeted energy delivery with EN would result in an annual cost reduction of $10.2 million compared with continued administration of EN alone.

Limitations: The cost calculation was limited to the average daily cost of stay and antibiotic use. The costs associated with other common complications of DRM, such as prolonged duration of mechanical ventilation or more frequent readmission, are unknown.

Conclusions: DRM imposes a substantial economic burden on Latin American countries, with critically ill patients accounting for a disproportionate share of costs. Cost–benefit analysis suggests that both improved clinical outcomes and significant cost savings can be achieved through the adoption of SPN as a therapeutic strategy in critically ill patients who fail to receive adequate nutrient intake from EN.

Keywords:

• Disease-related malnutrition
• pharmacoeconomics
• supplemental parenteral nutrition
• enteral nutrition
• intensive care
• Latin America

JEL classification codes:

• A10
• A12

Transparency

Declaration of funding

This study was funded by Fresenius Kabi Deutschland GmbH.

Author contributions

All authors co-designed the study, actively discussed the study results and finalized the manuscript.

Declaration of financial/other relationships

M.I.T.D.C. has disclosed that she has served as an advisor for Abbott and Baxter and received honoraria for lectures from Abbott, Baxter, Danone, Fresenius Kabi and Nestlé. M.I.P. has disclosed that he has served as an advisor and received honoraria for lectures from Fresenius Kabi. L.P. has disclosed that he has received research grants from Fresenius Kabi for the work under consideration, and received research grants and consulting fees from Fresenius Kabi, Amgen, GSK, Roche, Jannsen Cilag, Novartis and Livanova, among others, outside of the submitted work. A.O. has disclosed that he is an employee of AdRes SRL, which has received research grants from Fresenius Kabi for the work under consideration. D.L.W. has served as an advisor for Danone and received honoraria for lectures from Ache, B. Braun, Danone and Fresenius Kabi.

Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgements

We wish to thank Kenneth Glasscock (KFG Scientific Communications, United States) for medical writing and editorial assistance.