COST-EFFECTIVENESS OF PROVIDING FULL HOME ENTERAL NUTRITION THROUGH THE PUBLIC HEALTH SYSTEM IN SãO PAULO, BRAZIL
Author(s)
Stephani F. Mashki1, Erick Polli, PhD2, Kelvin Hiromiti Albuquerque Yokota, MSc, MD3, Mariane De Oliveira, PhD4.
1São Paulo, Brazil, 2FMUSP, São Paulo, Brazil, 3University of Sao Paulo, São Paulo, Brazil, 4Morrissey College of Arts & Sciences, Boston College, Chestnut Hill, MA, USA.
1São Paulo, Brazil, 2FMUSP, São Paulo, Brazil, 3University of Sao Paulo, São Paulo, Brazil, 4Morrissey College of Arts & Sciences, Boston College, Chestnut Hill, MA, USA.
OBJECTIVES: The State of São Paulo’s publicly funded Home Enteral Nutrition (HEN) Program provides industrialized formulas, but many patients receive only partial requirements and must supplement with homemade diets. This study evaluated the cost-effectiveness and budget impact of providing 100% industrialized HEN to beneficiaries enrolled in this program.
METHODS: Data from a sample of 673 older adults (aged ≥60 years) receiving gastrostomy enteral feeding were analyzed over a one-year follow-up period. The percentage of formula provided (30%, 50%, 70%, or 100%) served as a proxy for nutritional risk states, with patients receiving 100% representing the highest nutritional risk. A Markov model (3-year time horizon) compared usual care with a strategy providing 100% of the prescribed industrialized formula from the start of treatment to all participants, with transition probabilities estimated between the first and final assessments, using life-years gained as the primary outcome. Additionally, a budget impact analysis was conducted for all beneficiaries aged ≥18 years (n=11,650).
RESULTS: The 100% intervention increased discounted life-years from 2.91 to 3.19, generating an incremental gain of 0.28 life-years. The incremental cost was $1,444.86, yielding an incremental cost-effectiveness ratio of $5,153.84 per life-year gained. Sensitivity analysis showed a 76% probability of cost-effectiveness. Among all program beneficiaries aged ≥18 years, expanding full coverage would increase annual expenditures from $13.43 to $14.83 million, representing an incremental budget impact of $1.40 million. This equals an additional $119,49 per patient annually (~$9,90/month), reflecting a 10.4% increase in formula expenditures.
CONCLUSIONS: Providing full industrialized HEN to older adults enrolled in the HEN Program appears to be a cost-effective strategy. The relatively modest budget impact observed when extrapolating full formula coverage to all adult program beneficiaries suggests that expanding coverage through the public health system may be a feasible policy option to improve nutritional care and reduce malnutrition-related mortality.
METHODS: Data from a sample of 673 older adults (aged ≥60 years) receiving gastrostomy enteral feeding were analyzed over a one-year follow-up period. The percentage of formula provided (30%, 50%, 70%, or 100%) served as a proxy for nutritional risk states, with patients receiving 100% representing the highest nutritional risk. A Markov model (3-year time horizon) compared usual care with a strategy providing 100% of the prescribed industrialized formula from the start of treatment to all participants, with transition probabilities estimated between the first and final assessments, using life-years gained as the primary outcome. Additionally, a budget impact analysis was conducted for all beneficiaries aged ≥18 years (n=11,650).
RESULTS: The 100% intervention increased discounted life-years from 2.91 to 3.19, generating an incremental gain of 0.28 life-years. The incremental cost was $1,444.86, yielding an incremental cost-effectiveness ratio of $5,153.84 per life-year gained. Sensitivity analysis showed a 76% probability of cost-effectiveness. Among all program beneficiaries aged ≥18 years, expanding full coverage would increase annual expenditures from $13.43 to $14.83 million, representing an incremental budget impact of $1.40 million. This equals an additional $119,49 per patient annually (~$9,90/month), reflecting a 10.4% increase in formula expenditures.
CONCLUSIONS: Providing full industrialized HEN to older adults enrolled in the HEN Program appears to be a cost-effective strategy. The relatively modest budget impact observed when extrapolating full formula coverage to all adult program beneficiaries suggests that expanding coverage through the public health system may be a feasible policy option to improve nutritional care and reduce malnutrition-related mortality.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE366
Topic
Economic Evaluation, Epidemiology & Public Health, Health Technology Assessment
Disease
Gastrointestinal Disorders, Geriatrics, Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas, Nutrition