„Eure Nahrung soll Eure Medizin sein …“

Zusammenfassung

Hintergrund: Die krankheitsassoziierte Mangelernährung ist in Krankenhäusern immer noch ein häufiges Problem, das ein erhöhtes Risiko für medizinische Komplikationen bedingt und letztlich zur Verschlechterung der Lebensqualität und zu gesteigerten Behandlungskosten führt. Trotzdem bleibt die Mangelernährung aufgrund des mangelnden Problembewusstseins häufig unbemerkt und in Folge unbehandelt. Im folgenden Übersichtsartikel wird die ökonomische Bedeutung der Mangelernährung sowie der Ernährungsintervention analysiert.

Methodik: Eine umfassende Literatursuche in Pubmed sowie eine Durchsicht von Referenzen identifizierte 22 Studien in englischer oder deutscher Sprache, die entweder die Kosten einer Mangelernährung oder die Kosteneffektivität einer Ernährungsintervention untersuchten.

Ergebnisse: Acht Studien zu den stationären Kosten einer Mangelernährung; 5 Studien zur Kosteneffektivität einer Ernährungsintervention im stationären und 4 Studien im poststationären Bereich; 5 systematische Analysen zur Kosteneffektivität einer Ernährungsintervention auf nationaler Ebene wurden in der Übersichtsarbeit berücksichtigt. Eine Mangelernährung führt nachweislich zu einer signifikant höheren Krankenhausverweildauer, einer erhöhten Komplikationsrate sowie zu einer höheren Mortalität. Die zusätzlichen Behandlungskosten der Mangelernährung sind zwar durchgehend höher, werden aber aufgrund der Kosteneinsparungen durch den verbesserten klinischen Verlauf zumindest ausgeglichen. Die poststationäre Intervention mit Trinknahrung ist bei mangelernährten Patienten kosteneffektiv. Laut einer Budget-Impact-Analyse könnte eine indikationsgerechte Intervention mit Trinknahrung zu einer jährlichen Einsparung von ca. 600 Mio. € im deutschen Gesundheitswesen führen.

Schlussfolgerung: Vor dem Hintergrund knapper Ressourcen im Gesundheitssystem stellt eine Ernährungsintervention sowohl stationär als auch poststationär eine kosteneffektive Behandlung der krankheitsassoziierten Mangelernährung dar und trägt damit zu einer Vermeidung von weiteren gesundheitlichen Nachteilen bei.

Abstract

Background: Disease-related malnutrition in hospitals remains a prevalent issue. It causes increased medical complications and ultimately leads to reduced quality of life and increased treatment costs. In spite of this, malnutrition still remains unnoticed due to lack of awareness and, as a result, often goes untreated. The following review article considers the economic relevance of malnutrition and nutrition intervention.

Methods: An extensive search of the literature in Pubmed and a review of references identified 22 studies in English or German which either looked at the costs of malnutrition or the cost-effectiveness of a nutrition intervention.

Results: 8 studies regarding in-patient costs of malnutrition, 5 studies on the cost-effectiveness of an in-patient and 4 studies on that of an out-patient nutrition intervention, and 5 systematic analyses on the cost-effectiveness of a nutrition intervention on a national level, were considered in this review article. Malnutrition resulted in a significantly longer hospital stay, an increased rate of complications, as well as increased mortality. The additional treatment costs of malnutrition were consistently higher; however, they were counterbalanced by the savings of an improved clinical course. In selected settings, a post-hospital intervention with sip feeds was cost effective for malnourished patients. According to a budget impact analysis, an indication-appropriate intervention with sip feeds could lead to annual savings of approximately € 600 million in the German health care system.

Conclusion: In light of narrow resources in the health care system, nutritional intervention both in and out of hospital represents a cost-effective treatment of disease-related malnutrition and contributes to the prevention of further negative consequences.

Schlüsselwörter

krankheitsassoziierte Mangelernährung - Ernährungsintervention - Kosteneffektivität

Keywords

disease-related malnutrition - nutritional intervention - cost-effectiveness

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