Cost-effectiveness of health system strategies for older patients with malnutrition presenting in hospital

Malnutrition in the older adults is a hidden epidemic in many affluent regions of the world, including Australia. An estimated 30-43% of the aged (over 65) population in Australian acute and rehabilitation hospitals are malnourished. It is often underdiagnosed and undertreated. Older adults are at an increased risk of not getting the right balance of nutrients and calories needed to stay healthy. This is because as they age their dietary needs change as do their self-care ability and living arrangements, while the older adults are also more likely to develop malnutrition with acute or chronic diseases (disease-related malnutrition). Malnutrition often results in an impaired immune system and recovery from disease, higher morbidity, care needs and hospital readmission rates, longer hospitalisations, and a lower quality of life. The clinical and health system consequences of malnutrition point to far reaching downstream health and aged care needs and cost consequences of failing to adequately treat malnutrition in the older population. The objective of this thesis is to inform health and aged care decision makers about the cost-effectiveness of an integrated hospital care and discharge strategy aimed at improving health system care and cost impacts across care settings for malnourished older patients presenting in acute care hospitals in Australia. The thesis in addressing this undertakes evidence synthesis combining health economic analysis of nutritional epidemiological studies in older patients with or at risk of malnutrition in the Australian acute hospital setting with trial evidence of the Re-Engineered discharge (RED) model of care. Importantly for the older population with or at risk of malnutrition, the RED care model has been shown to reduce rehospitalisation while addressing care continuity across the health and aged care system more generally