Economic burden of hospital malnutrition and the cost–benefit of supplemental parenteral nutrition in critically ill patients in Latin America

Abstract

Aim: Disease-related malnutrition (DRM) is a prevalent condition that significantly increases the risk of adverse outcomes in hospitalized patients, particularly those with critical illness. Limited data is available on the economic burden of DRM and the cost–benefit of nutrition therapy in high-risk populations in Latin America. The aims of the present study were to estimate the economic burden of DRM and evaluate the cost–benefit of supplemental parenteral nutrition (SPN) in critically ill patients who fail to receive adequate nutrient intake from enteral nutrition (EN) in Latin America.

Methods: Country-specific cost and prevalence data from eight Latin American countries and clinical data from studies evaluating outcomes in patients with DRM were used to estimate the costs associated with DRM in public hospitals. A deterministic decision model based on clinical outcomes from a randomized controlled study and country-specific cost data were developed to examine the cost–benefit of administering SPN to critically ill adults who fail to reach ≥60% of the calculated energy target with EN.

Results: The estimated annual economic burden of DRM in public hospitals in Latin America is $10.19 billion (range, $8.44 billion–$11.72 billion). Critically ill patients account for a disproportionate share of the costs, with a 6.5-fold higher average cost per patient compared with those in the ward ($5488.35 vs. $839.76). Model-derived estimates for clinical outcomes and resource utilization showed that administration of SPN to critically ill patients who fail to receive the targeted energy delivery with EN would result in an annual cost reduction of $10.2 million compared with continued administration of EN alone.

Limitations: The cost calculation was limited to the average daily cost of stay and antibiotic use. The costs associated with other common complications of DRM, such as prolonged duration of mechanical ventilation or more frequent readmission, are unknown.

Conclusions: DRM imposes a substantial economic burden on Latin American countries, with critically ill patients accounting for a disproportionate share of costs. Cost–benefit analysis suggests that both improved clinical outcomes and significant cost savings can be achieved through the adoption of SPN as a therapeutic strategy in critically ill patients who fail to receive adequate nutrient intake from EN.     

A note resolving the debate on “The weighted average cost of capital is not quite right”

Miller (2009a) derives a weighted average cost of capital for the special case where the cash flows to equity and the cash flows to debt are annuities. The paper attracts debate. We show that the weighted average cost of capital is redundant in a world where interest paid is not tax deductible. The required rate of return on unlevered equity will consistently and reliably estimate the net present value of any project no matter the idiosyncratic beliefs of the analyst as to the year-by-year leverage of the project, or of the firm. We recommend that the weighted average cost of capital method is discarded.     

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This article purports to explain the current account behavior for Canada in the context of the twin-deficit hypothesis. The study tests the validity of the hypothesis in a model in which domestic savings and investment are explicitly considered. In this article we use the cointegration analysis to investigate the secular relationship between the fiscal and current account deficits. We also estimate an error correction model to capture the short-run dynamics of the relationship. A major finding of this study is that the current account deficit seems to be related both to the fiscal deficit and the savings—investment gap.     

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Does Religion Matter? A Comparison Study of the Ethical Beliefs of Marketing Students of Religious and Secular Universities in Japan

This study was designed to examine the determinants of and differences between the ethical beliefs of two groups of Japanese students in religious and secular universities. Multiple regression analysis revealed that students of the Japanese religious university perceived that young, male, relativistic, and opportunistic students tended to behave less ethically than did older, female, and idealistic students. Students of the Japanese secular university perceived that male, achievement-oriented, and opportunistic students tended to behave less ethically than did female and experience-oriented students. Opportunism was found to be one of the most important determinants in explaining misconduct. Multivariate analysis of variance (MANOVA) and multiple discriminant analysis (MDA) revealed that students of the Japanese secular university tended to score higher on achievement and humanism, and lower on theism and positivism than did students of the Japanese religious university. In addition, students of the Japanese secular university were somewhat more sensitive to academic dishonesty practices than were students of the Japanese religious university.     

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Most wholesalers are small family-owned firms that frequently lack marketing skills and an infrastructure capable of setting into practice state-of-the-art marketing distribution systems. They are much more consumed with daily activities and credit and collection functions than they are with developing marketing skills and logistics networks. The purpose of this exploratory study is to identify the elements of marketing skills and logistics that are associated with the performance of small and large wholesalers, and to compare and contrast these variables. Data were collected from 4500 small and large wholesalers in Hyogo and Osaka prefectures in Japan. Multiple regression analysis of this study found that the factors of supplier's financial assistance and buyer's services to wholesalers explained the performance of small wholesalers, and the factors of supplier's service to wholesalers and buyer's service to wholesalers explained the performance of large wholesalers. Multivariate analysis of variance and multiple discriminant analysis revealed that large and small wholesalers differed with respect to supplier's services to wholesalers, the supplier's financial assistance, and the wholesaler's intra logistics activities. Implications are discussed.