Home artificial nutrition : costs and consequences : a systematic literature review

Abstract

Malnutrition affects health clinical status and health outcomes, occurring both in hospital and community setting. Despite recognized as a health care concern, it still is not adequately diagnosed and treated. Home Artificial Nutrition had its turning point with changes in hospital healthcare reimbursement system and development of home care technologies. Objectives: This thesis aims a better understanding of the health economics related to this home nutritional therapy, assessing the current evidence, namely on costs and consequences. Material and Methods: A systematic review of literature was made using several databases and different keyword combinations related to the subject. Complementary search was made in general search engines and other websites related with Enteral and Parenteral Nutrition. The following steps were removal of article duplication, Title and Abstract evaluation and the final selected ones were subject to full reading. Starting with an initial pool of 583 articles, 116 we were mentioned in this work. Results: Home Artificial Nutrition programs are increasingly at use around the world. Outcomes rely heavily on the underlying disease and patient Quality of Life is difficult to assess due to the differences of home nutrition programs and lack of specific tools able to measure and follow-up changes over treatment. Costs vary significantly according to countries and nutritional therapy and most of the times calculated from a payer perspective. Few studies relate costs and consequences simultaneously and most are developed from a National Health Service or Insurance perspective with a limited evaluation of a wider societal benefit. The existence of a multidisciplinary nutrition support team is crucial for the successful implementation of this therapy. Conclusions: Home Artificial Nutrition is a valid clinical alternative for clinically stable patients, allowing relocation from hospital to home with cost reduction to health care services and increase of patient Quality of Life. Harmonization should be performed in several areas: clinical and follow-up practices, accessibility, legislation and reimbursement and more scientific research is necessary for a better understanding of costs and benefits of home nutritional support. Portugal should take steps in legislative path for developing and harmonize program implementation across the country.