Voedingseconomie

Summary

Nutrition Economics. Disease related malnutrition & the economic health care value of medical nutrition
Karen Freijer

Calculation of the costs of disease related malnutrition in The Netherlands and the health economic value of medical nutrition in its management in The Netherlands as well as on the international level. The further development of Nutrition Economics as a new field within Health Economics.

Aim
The aims of this thesis were threefold. The first aim was to estimate the economic burden of disease related malnutrition (DRM) in The Netherlands, as this is still a very common problem within the health care. The second aim was to calculate the cost-effectiveness of enteral medical nutrition in its management, as guidelines indicate the use of this nutrition. To determine which methodological issues are related to the health economic assessment of enteral medical nutrition in this field was the third aim.

Methods
By using a costofillness analysis the additional costs of DRM in The Netherlands was estimated for all health care settings. The cost-effectiveness and budget impact of using enteral medical nutrition within the Dutch management of DRM was calculated for different patients in different settings by using health economic evaluations. To have a good overview of the international economic value of this nutrition in the management of DRM, a systematic review was performed in which economic evaluations of enteral medical nutrition in the management of DRM were reviewed and qualified. An international expert workshop was organized to explore and discuss the appropriate health economic assessment methods for this medical nutrition in the management of DRM.

Results
The total additional costs of DRM in adult patients in all Dutch health care settings were estimated to be € 1.9 billion in 2011 which equals 2.1% of the total Dutch national health expenditure. The total additional costs for DRM were four times higher for the elderly patients (60 years of age and older) than for patients in the age category of >18 and <60 (€ 403 million) and most costs (66%) were attributable to the hospital setting (€ 1.2 billion). Using oral medical nutrition in the management of Dutch abdominal adult surgery patients suffering from DRM seemed to reduce costs with a € 252 (7.6%) cost saving per patient, leading to an annual cost saving of a minimum of € 40.4 million per annum. A total annual cost saving of € 13 million (4.7% savings) resulted from using oral medical nutrition in community dwelling elderly (>65 years) with DRM in The Netherlands. The additional costs of the oral medical nutrition were more than balanced in both economic evaluations. The systematic review showed that oral enteral medical nutrition was the most studied intervention in the published international economic evaluations, covering several patient populations and different health care settings. Based on the high quality economic analyses it could be concluded that enteral medical nutrition in the management of DRM can be efficient from a health economic perspective. An unequivocal way of estimating the cost-effectiveness of this nutrition is advisable. Experts concluded that although the general methods for performing health economic evaluations can be applied to medical nutrition as to any other health technology, specific characteristics of medical nutrition do need special attention.

Conclusions
DRM is a costly health care problem, also in The Netherlands. Medical nutrition in its total management can save costs within the Dutch health care system as well on an international level. Unequivocal methods are needed though regarding health economics for nutrition, being nutrition economics