RESUMEN
INTRODUCTION: disease-related malnutrition has a high prevalence, with clinical consequences potentially severe for the patient, and of high economic impact for the healthcare system. OBJECTIVE: to perform a review of the literature regarding the economic burden of disease-related malnutrition, to assess complications, and to determine the usefulness of enteral or oral nutritional supplementation from a cost analysis perspective. METHODS: a review of the literature up to June 2016 was carried out regarding economic costs of disease-related malnutrition and cost analysis of nutritional treatment, with special focus on retrieval of systematic reviews, meta-analysis, and randomized clinical trials. RESULTS: a total of 31 publications were selected, 15 on costs of disease-related malnutrition and 16 on costs of treatment. Disease-related malnutrition increases health care costs in relation to a longer hospital stay, higher incidence of infectious and non-infectious complications, greater need of treatment, increase in readmissions, more prolonged stay in the intensive care unit and/or the need of referral to continuing care centers at discharge. Publications regarding treatment with oral nutritional supplements suggest that these oral supplements are cost-effective and cost-beneficial both in ambulatory and hospitalized patients. CONCLUSIONS: disease-related malnutrition causes an increase in health care costs that could be minimized, among other approaches, by an early diagnosis and treatment for which oral nutritional supplements are cost-effective and cost-beneficial.
Asunto(s)
Desnutrición/economía , Desnutrición/terapia , Análisis Costo-Beneficio , Suplementos Dietéticos , Costos de la Atención en Salud , HumanosRESUMEN
Introducción: la desnutrición relacionada con la enfermedad tiene una elevada prevalencia, con consecuencias clínicas potencialmente graves para el paciente y de alto impacto económico para el sistema sanitario. Objetivos: realizar una revisión de la literatura sobre los costes económicos de la desnutrición asociada a la enfermedad, analizar sus complicaciones y evaluar la utilidad de la nutrición enteral u oral bajo la perspectiva del análisis de costes. Métodos: se llevó a cabo una revisión de la literatura hasta junio de 2016 sobre los costes económicos de la desnutrición y el análisis de costes del tratamiento nutricional, priorizando las revisiones sistemáticas, los metaanálisis y los ensayos clínicos aleatorizados. Resultados: se identificaron 31 publicaciones, 15 sobre los costes de la desnutrición relacionada con la enfermedad y 16 de análisis de costes del tratamiento. La desnutrición relacionada con la enfermedad incrementa los costes sanitarios por una mayor estancia hospitalaria, mayor incidencia de complicaciones infecciosas y no infecciosas, mayor necesidad de tratamientos, incremento de los reingresos, estancias más prolongadas en unidades de cuidados intensivos y/o la necesidad de derivación al alta a centros de continuación de cuidados. Las publicaciones evaluadas sobre el tratamiento mediante suplementos nutricionales orales sugieren que los suplementos nutricionales orales son coste-efectivos y coste-útiles tanto en pacientes ambulatorios como en pacientes hospitalizados. Conclusiones: la desnutrición relacionada con la enfermedad produce un incremento de los costes sanitarios que podría minimizarse, entre otras formas, mediante un diagnóstico y tratamiento precoz de la misma, para lo cual los suplementos nutricionales orales constituyen una herramienta coste-eficaz y coste-útil
Introduction: disease-related malnutrition has a high prevalence, with clinical consequences potentially severe for the patient, and of high economic impact for the healthcare system. Objective: to perform a review of the literature regarding the economic burden of disease-related malnutrition, to assess complications, and to determine the usefulness of enteral or oral nutritional supplementation from a cost analysis perspective. Methods: a review of the literature up to June 2016 was carried out regarding economic costs of disease-related malnutrition and cost analysis of nutritional treatment, with special focus on retrieval of systematic reviews, meta-analysis, and randomized clinical trials. Results: a total of 31 publications were selected, 15 on costs of disease-related malnutrition and 16 on costs of treatment. Disease-related malnutrition increases health care costs in relation to a longer hospital stay, higher incidence of infectious and non-infectious complications, greater need of treatment, increase in readmissions, more prolonged stay in the intensive care unit and/or the need of referral to continuing care centers at discharge. Publications regarding treatment with oral nutritional supplements suggest that these oral supplements are cost-effective and cost-beneficial both in ambulatory and hospitalized patients. Conclusions: disease-related malnutrition causes an increase in health care costs that could be minimized, among other approaches, by an early diagnosis and treatment for which oral nutritional supplements are cost-effective and cost-beneficial
Asunto(s)
Humanos , Hospitalización/estadística & datos numéricos , Desnutrición/epidemiología , Apoyo Nutricional/estadística & datos numéricos , Suplementos Dietéticos/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Alimentos FortificadosRESUMEN
Biliary atresia leads to cirrhosis in the vast majority of patients and constitutes the first cause of paediatric liver transplantation. Animal models allow us to understand the molecular basis and natural history of diseases. The aim of this study is to describe a surgically created animal model of biliary atresia with emphasis in long-term liver function. Forty-two 3-week-old Sprague-Dawley rats were randomly divided into two groups: bile duct ligature (BDL) and control. The animals were sacrificed on the 2nd, 4th, and 6th postoperative weeks. Blood samples were collected for liver function analysis. The spleen to body weight ratio was determined. Histopathological examination of liver tissue was performed by hematoxylin-eosin and Sirius red staining. Collagen quantification was determined by using colorimetric digital image analysis and was expressed as a percentage of total liver tissue area. Quantitative real-time polymerase chain reaction was performed to analyse gene expression levels of transforming growth factor-ß1 (Tgfb1) and apeline (Apln) genes. Statistical analysis was performed where P<0.05 was considered significant. Animals from BDL group developed increasing cholestasis with clinical and laboratory features. Splenomegaly was detected at 4th and 6th week (P<0.05). Histological evaluation of the liver showed ductular reaction, portal fibrosis and bile plugs. Collagen area to total liver tissue area had a median of 2.5% in the control group and 6.5 %, 14.3 % and 37.7 % in BDL rats at 2nd, 4th and 6th weeks respectively (P<0.001). Tgfb1 mRNA expression level was significantly higher at 6th week (P<0.001) in BDL group when compared to control. Apln mRNA expression level was significantly higher at 4th and 6th week (P<0.001) and showed a positive linear correlation (r = 0.975, P<0.05) in BDL group when compared to control. Bile duct ligature in young rats is an animal model that recreates clinical, laboratory, histological and molecular findings of biliary atresia. Bile duct ligature constitutes a good animal model to investigate therapeutic approaches for modifying the progression of liver fibrosis in biliary atresia.