title: Cost-effectiveness of a disease-specific oral nutritional support for pressure ulcer healing.
abstract: The Oligo Element Sore Trial has shown that supplementation with a disease-specific nutritional formula enriched with arginine, zinc, and antioxidants improves pressure ulcer (PU) healing in malnourished patients compared to an isocaloric-isonitrogenous support. However, the use of such a nutritional formula needs to be supported also by a cost-effectiveness evaluation.
  
  
  
  This economic evaluation - from a local healthcare system perspective - was conducted alongside a multicenter, randomized, controlled trial following a piggy-back approach. The primary efficacy endpoint was the percentage of change in PU area at 8 weeks. The cost analysis focused on: the difference in direct medical costs of local PU care between groups and incremental cost-effectiveness ratio (ICER) of nutritional therapy related to significant study endpoints (percentage of change in PU area and ≥40% reduction in PU area at 8 weeks).
  
  
  
  Although the experimental formula was more expensive (mean difference: 39.4 Euros; P < 0.001), its use resulted in money saving with respect to both non-nutritional PU care activities (difference, -113.7 Euros; P = 0.001) and costs of local PU care (difference, -74.3 Euros; P = 0.013). Therefore, given its efficacy it proved to be a cost-effective intervention. The robustness of these results was confirmed by the sensitivity analyses.
  
  
  
  The use of a disease-specific oral nutritional formula not only results in better healing of PUs, but also reduces the costs of local PU care from a local healthcare system perspective.
authors.affiliation: Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cereda
authors.affiliation: Servizio di Biometria e Statistica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: SS di Prevenzione e Cura Lesioni Vascolari, ASL NO, Novara, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Andreola
authors.affiliation: Medical Department, Nutricia Italia, Milano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pisati
authors.affiliation: Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands; Dept. HSR, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands; Dept. Family Medicine, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands.
authors.forename: Jos M G A
authors.initials: JM
authors.lastname: Schols
authors.affiliation: Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Caccialanza
authors.affiliation: SCDO Dietetica e Nutrizione Clinica, Azienda Ospedaliera Universitaria "Maggiore della Carità", Novara, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: D'Andrea
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage / Q000191:economics; D001120:Arginine / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D019587:Dietary Supplements / Q000191:economics*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000188:drug therapy / Q000191:economics; D003668:Pressure Ulcer / Q000188:drug therapy* / Q000191:economics; D014945:Wound Healing / Q000187:drug effects*; D015032:Zinc / Q000008:administration & dosage / Q000191:economics
chemical_list: D000975:Antioxidants; D001120:Arginine; D015032:Zinc
keywords: Cost-effectiveness; Healing; Incremental cost-effectiveness ratio; Oral nutritional support; Pressure ulcers