title: Impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk: A prospective cohort study with propensity score matching.
abstract: OBJECTIVE
  There is a lack of evidence regarding the economic effects of nutrition support in patients at nutritional risk. The aim of this study was to perform a cost-effectiveness analysis by comparing an adequate nutrition support cohort with a no-support cohort.
  
  
  METHODS
  A prospective observational study was performed in the surgical and medical gastroenterology wards. We identified patients at nutritional risk and the provision of nutrition support by the staff, unaware of the risk status, was recorded. Cost data were obtained from each patient's statement of accounts, and effectiveness was measured by the rate of infectious complication. To control for potential confounding variables, the propensity score method with matching was carried out. The incremental cost-effectiveness ratio was calculated based on the matched population.
  
  
  RESULTS
  We screened 3791 patients, and 440 were recruited for the analysis. Patients in the nutrition support cohort had a lower incidence of infectious complications than those in the no-support cohort (9.1 versus 18.1%; P = 0.007). This result was similar in the 149 propensity matched pairs (9.4 versus 24.2%; P < 0.001). The median hospital length of stay was significantly reduced among the matched nutrition support patients (13 versus 15 d; P < 0.001). The total costs were similar among the matched pairs (US $6219 versus $6161). The incremental cost-effectiveness analysis suggested that nutrition support cost US $392 per patient prevented from having infectious complications.
  
  
  CONCLUSIONS
  Nutrition support was associated with fewer infectious complications and shorter length of stay in patients at nutritional risk. The incremental cost-effectiveness ratio indicated that nutrition support had not increased costs significantly.
authors.affiliation: Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Department of Nursing School, Chongqing Medical University, Chongqing, China; Guizhou Provincial People's Hospital, Guizhou, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. Electronic address: jiangzm@imicams.ac.cn.
authors.forename: Zhu-Ming
authors.initials: ZM
authors.lastname: Jiang
authors.affiliation: Nutrition Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Kondrup
authors.affiliation: China Center for Health Development Studies, Peking University, Beijing, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Fang
authors.affiliation: School of Nursing, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Martha
authors.initials: M
authors.lastname: Andrews
authors.affiliation: School of Nursing, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Marie T
authors.initials: MT
authors.lastname: Nolan
authors.affiliation: Department of Nursing School, Chongqing Medical University, Chongqing, China.
authors.forename: Shao-Yu
authors.initials: SY
authors.lastname: Mu
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Nutrition, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Yu
authors.affiliation: Department of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Kang
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000191:economics*; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Cost-effectiveness analysis; Nutrition support; Nutritional Risk Screening 2002; Propensity score matching