Resumen
Introducción: Las estrategias nutricionales y dietéticas tienen por objetivo mejorar la salud. Los estudios de costos económicos permiten evaluar intervenciones, así como observar los costos y los beneficios. Se han desarrollado estrategias nutricionales cuyo costo sea bajo y cuya efectividad sea alta para disminuir la incidencia de enfermedades, por lo que desempeñan un papel importante en la recuperación y preservación de la salud. Material y métodos: Se realizó una búsqueda sistemática en las diferentes bases de datos, en la cual se incluyeron artículos costo-efectividad desde el punto de vista institucional, de intervenciones nutricionales y dietéticas desde 1980 a 2018. Los estudios se agruparon de acuerdo al tipo de intervención. Se comparó el objetivo de cada estudio con las diferencias de los estudios de simulación y de los estudios clínico-económicos. Resultados: Se incluyeron 34 artículos. Todos eran ensayos clínicos aleatorizados, tanto en los estudios tomados de la literatura para hacer los estudios de simulación como en los estudios clínico-económico. Conclusiones: No todas las publicaciones reportan las unidades de efectividad en el mismo sistema monetario, ni definen efectividad de la misma manera, sin embargo, las estrategias de intervención nutricionales y dietéticas demuestran ser efectivas al reducir los días de hospitalización y al mejorar los pronósticos vitales y el estado de salud en general de los pacientes, por lo que su costo no solo es amortizable, sino que debería considerarse como parte esencial de las intervenciones sanitarias.
Citas
Banks, M.D., Graves, N., Bauer, J.D. y Ash, S. (2013). Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals. Eur J Clin Nutr. 67(1),42-46. doi: 10.1038/ejcn.2012.140.
Bentley, T. G., Weinstein, M.C., Willett, W. C. y Kuntz, K.M. (2008). A cost-effectiveness analysis of folic acid fortification policy in the United States. Public Health Nutrition, 12(4), 455-467. doi: 10.1017/S1368980008002565.
Bergmann, J.N., Legins, K., Sint, T.T., Snidal, S.; UNICEF Research Group, Amor, Y.B. y McCord, G.C. (2016). Outcomes and Cost-Effectiveness of Integrating HIV and Nutrition Service Delivery: Pilots in Malawi and Mozambique. AIDS Behav. 21(3),703-711. doi: 0.1007/s10461-016-1400-3.
Brown, K.H., Hess, S.Y., Vosti, S.A. y Baker, S.K. (2013). Comparison of the estimated cost-effectiveness of preventive and therapeutic zinc supplementation strategies for reducing child morbidity and mortality in sub-Saharan Africa. Food Nutr Bull, 34(2),199-214. doi: 10.1177/156482651303400209.
Buckley, L. M. y Hillner, B.E. (2003). A cost effectiveness analysis of calcium and vitamin D sup-plementation, etidronate, and alendronate in the prevention of vertebral fractures in women treated with glucocorticoids. International Journal of Rheumatology, 30(1), 132-138.
Casey, G. J., Sartori, D., Horton, S. E., Phuc, T. Q., Phu, L. B., Thach, D. T., … y Biggs, B. A. (2011). Weekly iron-folic acid supplementation with regular deworming is cost-effective in preventing anemia in women of reproductive age in Vietnam. Public Library of Science, 6(9), e23723. doi: 10.1371/journal.pone.0023723.
Dalziel, K., Segal, L. y Katz, R. (2010). Cost-effectiveness of mandatory folate fortification v. oth-er options for the prevention of neural tube defects: results from Australia and New Zealand. Public Health Nutrition, 13(4), 566-578. doi: 10.1017/S1368980009991418.
Davey, P. J., Schulz, M., Gliksman, M., Dobson, M., Aristides, M. y Stephens, N. G. (1998). Cost-effectiveness of vitamin E therapy in the treatment of patients with angiographically proven coronary narrowing (CHAOS trial). Cambridge Heart Antioxidant Study. American Journal of Cardiology, 82(4), 414-417.
Eussen, R.B.M., Verhagen, H., Olaf, H., Klungel, H., Garssen, J., Henk van Loveren, H., … y Rompelberg, C. (2010). Functional foods and dietary supplements: Products at the interface between pharma and nutrition. European Journal of Pharmacology. 668(1), S2-S9. doi: 10.1016/j.ejphar.2011.07.008.
Fiedler, J. L. y Afidra, R. (2010). Vitamin A fortification in Uganda: comparing the feasibility, cov-erage, costs, and cost-effectiveness of fortifying vegetable oil and sugar. Food and Nutrition Bulletin, 31(2), 193-205. doi: 10.1177/156482651003100202.
Giraldo-Giraldo, N.A., Vásquez-Velásquez, J., Roldán-Cano, P.A., Ospina-Astudillo, C. y Sosa-Cardona, Y.P. (2015). Cost-effectiveness of early nutritional therapy in malnourished adult patients in a high complexity hospital. Nutr Hosp., 32(6), 2938-2947. doi:10.3305/nh.2015.32.6.9859.
Gómez Candela, C., Cantón Blanco, A., Luengo Perez, L. M. y Fuster, G. O. (2010). Efficacy, cost-effectiveness, and effects on quality of life of nutritional supplementation. Nutr Hosp, 25(5), 781-792.
Heaney, R.P., Dowell, M.S., Bierman, J., Hale, C. A. y Bendich, A. (2001). Absorbability and cost effectiveness in calcium supplementation. Journal of the American Collage of Nutrition, 20(3), 239-246.
Henry, C. J. (2010). Functional foods. European Journal Clinical Nutrition, 64, 657-659. doi: 10.1038/ejcn.2010.101.
Howlett, J. (2008). Functional Foods: from Science to Health and Claims. ILSI Europe Concise Monograph (pp. 1–36). Recuperado de https://ilsi.org/publication/functional-foods-from-science-to-health-and-claims/
Kagin, J., Vosti, S.A., Engle-Stone, R., Rettig, E., Brown, K.H., Nankap, M. y Ndjebayi, A. (2015). Measuring the Costs of Vitamin A Interventions: Institutional, Spatial, and Temporal Issues in the Context of Cameroon. Food Nutr Bull., 36(3 Suppl), S172-92. doi: 10.1177/0379572115598445.
Lee, R.H., Weber, T. y Colón-Emeric, C. (2013). Comparison of Cost-Effectiveness of Vitamin D Screening with That of Universal Supplementation in Preventing Falls in Community-Dwelling Older Adults. J Am Geriatr Soc., 61(5), 707-714. doi: 10.1111/jgs.12213.
Lilliu, H., Pamphile, R., Chapuy, M. C., Schulten, J., Arlot, M. y Meunier, P. J. (2003). Calcium-vitamin D3 supplementation is cost-effective in hip fractures prevention. Maturitas, 44(4), 299-305. doi: 10.1016/S0378-5122(03)00038-0.
Llanos, A., Hertrampf, E., Cortes, F., Pardo, A., Grosse, S. D. y Uauy, R. (2007). Cost-effectiveness of a folic acid fortification program in Chile. Health Policy, 83(2-3), 295-303. doi: 10.1016/j.healthpol.2007.01.011.
Loevinsohn, B.P., Sutter, R. W. y Costales, M. O. (1997). Using cost-effectiveness analysis to eval-uate targeting strategies: the case of vitamin A supplementation. Health Policy Plan, 12(1), 29-37.
Norman, K., Pirlich, M., Smoliner, C., Kilbert, A., Schulzke, J. D., Ockenga, J., … y Reinhold, T. (2011). Cost-effectiveness of a 3-month intervention with oral nutritional supplements in dis-ease-related malnutrition: a randomised controlled pilot study. European Journal of Clinical Nutrition, 65(6), 735-742. doi: 10.1038/ejcn.2011.31.
Nuijten, M., Andress, D. L., Marx, S. E., Curry, A. S. y Sterz, R. (2010). Cost Effectiveness of Pa-ricalcitol versus a non-selective vitamin D receptor activator for secondary hyperparathyroid-ism in the UK: a chronic kidney disease markov model. Clinical Drug Investigation, 30(8), 545-557. doi: 10.2165/11536310-000000000-00000.
Postma, M. J., Londeman, J., Veenstra, M., de Walle, H. E. y de Jong-van den Berg, L. T. (2012). Cost-effectiveness of periconceptional supplementation of folic acid. Pharmacy World and Science, 24(1), 8-11.
Pradelli, L., Eandi, M., Povero, M., Mayer, K., Muscaritoli, M., Heller, A.R. y Fries-Schaffner E. (2014). Cost-effectiveness of omega-3 fatty acid supplements in parenteral nutrition therapy in hospitals: a discrete event simulation model. Clin Nutr. 33(5), 785-792. doi: 10.1016/j.clnu.2013.11.016.
Pradelli, L., Iannazzo, S., Zaniolo, O., Muscaritoli, M. y Eandi, M. (2012). Effectiveness and cost-effectiveness of supplemental glutamine dipeptide in total parenteral nutrition therapy for crit-ically ill patients: a discrete event simulation model based on Italian data. International Jour-nal of Technology Assessment in Health Care, 28(1), 22-28. doi: 10.1017/S0266462311000705.
Rein, D. B., Saaddine, J. B., Wittenborn, J. S., Wirth, K. E., Hoerger, T. J., Narayan, K. M.,… Sorensen, S. W. (2007). Cost-effectiveness of vitamin therapy for age-related macular degen-eration. Ophthalmology, 114(7), 1319-1326. doi: 10.1016/j.ophtha.2006.10.041
Rouse, D. J. (2003). Potential cost-effectiveness of nutrition interventions to prevent adverse preg-nancy outcomes in the developing world. Journal of Nutrition, 133(5 Suppl 2), 1640S-1644S. doi: 10.1093/jn/133.5.1640S.
Sanabria, A., Domínguez, L. C., Vega, V., Osorio, C. y Duarte, D. (2011). Cost-effectiveness anal-ysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia. Revista de Salud Pública (Bogota), 13(5), 804-813.
Schmier, J. K., Rachman, N. J. y Halpern, M. T. (2006). The cost-effectiveness of omega-3 supple-ments for prevention of secondary coronary events. Managed Care, 15(4), 43-50.
Simmons, S.F., Keeler, E., An, R., Liu, X., Shotwell, M.S., Kuertz, B.,… y Schnelle JF. (2015). Cost-Effectiveness of Nutrition Intervention in Long-Term Care. J Am Geriatr Soc., 63(11), 2308-2316. doi: 10.1111/jgs.13709.
Simmons, S. F., Zhuo, X. y Keeler, E. (2010). Cost-effectiveness of nutrition interventions in nurs-ing home residents: a pilot intervention. Journal Nutrition Health Aging, 14(5), 367-372.
Stevenson, M. D. y Jones, M. L. (2011). The cost effectiveness of a randomized controlled trial to establish the relative efficacy of vitamin K1 compared with alendronate. Medical Decision Making, 31(1), 43-52. doi: 10.1177/0272989X10364848.
Sutherland, T. y Bishai, D. M. (2009). Cost-effectiveness of misoprostol and prenatal iron supple-mentation as maternal mortality interventions in home births in rural India. International Jour-nal of Gynaecology and Obstetrics, 104(3), 189-193. doi: 10.1016/j.ijgo.2008.10.011.
Tice, J. A., Ross, E., Coxson, P. G., Rosenberg, I., Weinstein, M. C., Hunink, M. G.,…y Goldman, L. (2001). Cost-effectiveness of vitamin therapy to lower plasma homocysteine levels for the prevention of coronary heart disease: effect of grain fortification and beyond. Journal of the American Medical Association, 286(8), 936-943.
Tuffaha, H.W., Roberts, S., Chaboyer, W., Gordon, L.G. y Scuffham, P.A. (2016). Cost-effectiveness Analysis of Nutritional Support for the Prevention of Pressure Ulcers in High-Risk Hospitalized Patients. Adv Skin Wound Care, 29(6), 261-267. doi: 10.1097/01.ASW.0000482992.87682.4c.
Wyers, C. E., Reijven, P. L., Evers, S. M., Willems, P. C., Heyligers, I. C., Verburg, A. D.,…Dagnelie, P. C. (2013). Cost-effectiveness of nutritional intervention in elderly subjects after hip fracture. A randomized controlled trial. Osteoporos Intertional. 24(1), 151-162. doi: 10.1007/s00198-012-2009-7.
Zhong, Y., Cohen, J.T., Goates, S., Luo, M., Nelson, J. y Neumann, P.J. (2016) The Cost-Effectiveness of Oral Nutrition Supplementation for Malnourished Older Hospital Patients. Appl Health Econ Health Policy, 15(1),75-83. doi: 10.1007/s40258-016-0269-7.