PP202-MON ENTERAL NUTRITION THERAPY IN CLOSED SYSTEM: VOLUME PRESCRIBED X VOLUME DELIVERED

Abstract

Rationale: In many countries sip feeding (oral nutritional supplements, ONS) at home is not covered by the compulsory health insurance, contrary to the service of tube feeding. The economic consequences of this statutory rule were analyzed and reimbursement of sip feeding was requested by the Swiss Federal Office of Public Health with success. Methods: Average treatment costs of sip and tube feeding were calculated. Additional costs and direct cost savings caused by the statutory rule were calculated. Indirect costs caused by malnutrition in Switzerland were estimated based on the commissioned report of the Swiss Federal Office of Public Health. Results: Tube feeding is more than twice as expensive as sip feeding (EUR 325 and 140, respectively), when adjusted for calories and period of treatment. 40% of sip feeding at home was not covered by the compulsory health insurance, leading to cost savings of EUR 250,000. However, in 10% of these cases tube feeding was initiated after refusal of the reimbursement of costs. The extra costs of these unnecessarily tube feedings amounted to approximately EUR 50,000 per year. Furthermore, malnutrition negatively affects rate of complications, mortality and effort for medical care. In Switzerland, this is responsible for additional costs of EUR 430,000,000 per year. Conclusion: The analysis shows that reimbursement of medically indicated ONS is cost-effective: Costs arising from reimbursement are largely covered by direct cost savings within 5 years. In the long term additional cost savings are expected by improving the therapy of malnourished patients and thereby reducing the costs generated by malnutrition.