Budget impact analysis of a muscle-targeted nutritional intervention for sarcopenia

In old adult patients with sarcopenia hospitalized for rehabilitation, the superior clinical benefit of a muscle-targeted formula (MTF; whey protein-based enriched with leucine and vitamin D) over an iso-caloric protein-free one was assessed through the IRIS trial (NCT03120026). The aim of this study is to further evaluate the economic benefit in the Italian context.

A cost-consequence secondary analysis was developed. Clinical inputs were evaluated over the course of the year in terms of nutrition cost, rehabilitation cost and modality of discharge (cost of staying at home vs institution) in three different payer perspectives: (1) hospital, including only nutrition and rehabilitation costs; (2) third-party payer (TPP), including also the economic consequences of patients discharged to an institution; and (3) societal perspective, including also the economic impact on families due to home assistance. For each one, the mean annual cost per patient was calculated. An estimation of the additional number of patients that could be hospitalized each year in Italy using the MTF was also computed.

The MTF was less expensive in all three perspectives considered. Mean saving per patient by perspective was: hospital, € 1536; TPP, € 10,540; societal, € 14,363. Rehabilitation was faster in patients taking the MTF resulting in lower costs to manage sarcopenia, though savings were mostly driven by patients being discharged at home instead of an institution. Finally, assuming a use of the MTF ranging from 50 % to 80 %, about 495,214-792,342 bed days could be saved meaning that 10,538-18,067 additional patients may be treated every year.

Costs associated with the nutritional support of adult patients with sarcopenia hospitalized for rehabilitation with a MTF were inferior than an iso-caloric formula in all payer perspectives. Furthermore, LOS was shorter and more patients could be hospitalized with the same number of beds.