OBJECTIVES: Dysphagia in stroke patients is a common and expensive complication, associated with increased mortality and morbidity due to aspiration, pneumonia, and malnutrition. We assessed the cost-utility of Nutilis Clear® (vs best supportive care) in adult stroke patients with dysphagia and 10–14 GUSS scale aspiration level (patients who tolerate semisolid intake but not fluids) from the public payer perspective in Poland.

METHODS: We built two models to assess the impact of model uncertainty: static (a fixed duration of dysphagia, 8 weeks) and dynamic (patient moves between health-states to reflect possible dysphagia resolution/recurrence within one year). In both, we accounted for the aspiration pneumonia reducing utility and increasing the risk of death; we assumed the intervention reduces the risk of aspiration pneumonia (not affecting dysphagia duration). The model parameters (e.g. dysphagia duration or transition probabilities) were based on available clinical data (primarily for the Polish population, if available) and consulted with clinical experts. The health states utilities were based on a systematic literature review. Unit costs were based on the National Health Fund data. Various forms of sensitivity analysis were performed (e.g. one-way, scenario, probabilistic).

RESULTS: The incremental cost-utility ratio was reassuringly similar in the static/dynamic model: 25,049 PLN/QALY and 22,327 PLN/QALY, respectively (1 EUR ≈ 4 PLN); below the official threshold of 134,514 PLN/QALY (QALY gain amounted to 0.029 and 0.017, respectively). All forms of sensitivity analysis demonstrate cost-effectiveness of using Nutilis Clear®, further proving the robustness of the results.

CONCLUSIONS: Even if clinical evidence is typically limited for dietary products, designing a cost-utility analysis is still possible. Modelling uncertainty can be reduced by juxtaposing the results of various modelling approaches. Funding of Nutilis Clear® for the dysphagia treatment is justified economically in the Polish settings.