Economic Evaluation of Individualized Nutritional Support for Hospitalized Patients with Chronic Heart Failure

Malnutrition is a highly prevalent risk factor in hospitalized patients with chronic heart failure (CHF). A recent randomized trial found lower mortality and improved health outcomes when CHF patients at nutritional risk received individualized nutritional treatment.To estimate the cost-effectiveness of individualized nutritional support in hospitalized patients with CHF.This analysis used data from CHF patients at risk of malnutrition (N=645) who were part of the Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial (EFFORT). Study patients with CHF were randomized to (i) an intervention group (individualized nutritional support to reach energy, protein, and micronutrient goals), or (ii) a control group (receiving standard hospital food). We used Markov modelling with daily cycles (over 6-month interval) to estimate hospital costs and health outcomes in the comparator groups, thus modeling cost-effectiveness ratios of nutritional interventions.With nutritional support, the modeled total additional cost over the 6-month interval was 15,159 Swiss francs (SF). With an additional 5.77 life days, overall incremental cost-effectiveness ratio for nutritional support vs no nutritional support was 2,625 SF per life day gained. In terms of complications, patients receiving nutritional support had a cost savings of 6,214 SF and an additional 4.11 life days without complications, yielding an incremental cost-effectiveness ratio for avoided complications of 1,513 SF per life day gained.Based on a Markov model, this economic analysis found that in-hospital nutritional support for CHF patients increases life expectancy at an acceptable incremental cost-effectiveness ratio