The financial burden of malnutrition in hospitalized pediatric patients under five years of age

BACKGROUND

Under-five children are a medically fragile group which is compromised by hospitalization. Malnutrition in those patients not only increases complications and mortality but also affects hospital resource utilization. Therefore, this study was conducted to clarify the impact of malnutrition on hospital expenditures.

METHODS

This prospective cohort study was performed at a tertiary hospital in Thailand. Under-five children who were admitted to general pediatric wards were included. Demographic data, the length of stay (LOS), and anthropometric measurements at admission were recorded. The classification of wasting and stunting were defined according to the World Health Organization (WHO) classification. Moreover, all hospital expenses were calculated directly based on the actual billing including the total hospital cost, cost of bed, enteral formula, medications, medical apparatus and procedures, nursing care, investigations and surgery.

RESULTS

One-hundred and five patients with a mean age of 26.8 ± 1.8 months were included. The majority of them were males (61%) with the leading cause of infectious disease. According to the prevalence of malnutrition, the percentage of patients who had only stunting or wasting were 24.8% and 10.5%, respectively while 15.2% of all patients had both stunting and wasting. Regardless of stunting, the wasting patients had a significantly higher cost of bed, enteral formula, nursing care, and medical apparatus. Particularly, the highest costs of all expenditures including the total hospital cost were found in patients who were both stunted and wasting. Apart from the financial burdens, the wasting patients stayed longer in the hospital and the LOS also significantly correlated with the total hospital cost (r = 0.84, p = 0.01).

CONCLUSIONS

The present study underscores the high prevalence of malnutrition in under-five pediatric patients. The malnourished patients, in particular the wasting group, had longer LOS and consequently had increased hospital expenses.

Malnutrition: laboratory markers vs nutritional assessment

Malnutrition is an independent risk factor for patient morbidity and mortality and is associated with increased healthcare-related costs. However, a major dilemma exists due to lack of a unified definition for the term. Furthermore, there are no standard methods for screening and diagnosing patients with malnutrition, leading to confusion and varying practices among physicians across the world. The role of inflammation as a risk factor for malnutrition has also been recently recognized. Historically, serum proteins such as albumin and prealbumin (PAB) have been widely used by physicians to determine patient nutritional status. However, recent focus has been on an appropriate nutrition-focused physical examination (NFPE) for diagnosing malnutrition. The current consensus is that laboratory markers are not reliable by themselves but could be used as a complement to a thorough physical examination. Future studies are needed to identify serum biomarkers in order to diagnose malnutrition unaffected by inflammatory states and have the advantage of being noninvasive and relatively cost-effective. However, a thorough NFPE has an unprecedented role in diagnosing malnutrition.

Tutorial on health economics and outcomes research in nutrition

As healthcare costs climb around the world, public and private payers alike are demanding evidence of a treatment's value to support approval and reimbursement decisions. Health economics and outcomes research, or HEOR, offers tools to answer questions about a treatment's value, as well as its real-world effects and cost-effectiveness. Given that nutrition interventions have to compete for space in budgets along with biopharmaceutical products and devices, nutrition is now increasingly coming to be evaluated through HEOR. This tutorial introduces the discipline of HEOR and motivates its relevance for nutrition. We first define HEOR and explain its role and relevance in relation to randomized controlled trials. Common HEOR study types--including burden of illness, effectiveness studies, cost-effectiveness analysis, and valuation studies--are presented, with applications to nutrition. Tips for critically reading HEOR studies are provided, along with suggestions on how to use HEOR to improve patient care. Directions for future research are discussed.