ABSTRACT
OBJECTIVE: This study assessed the therapeutic benefits and modeled the cost-effectiveness of oral nutritional supplements (ONS) in China. METHODS: Data were collected from 27 152 adult inpatients between January 1, 2018, and December 31, 2020. Propensity score matching was used for balancing the baseline characteristics between the ONS group and non-ONS group. A decision-tree model was developed to assess the cost-effectiveness of ONS for patients with nutritional risk, and the incremental cost-effectiveness ratio was the metric to determine the most cost-effective strategy. One-way sensitivity and probabilistic sensitivity analyses were conducted to assess the model's stability. In addition, subgroup analysis was conducted based on clinical characteristics. Differences in clinical outcomes between the groups were compared using Student's t test, Mann-Whitney U test, or chi-square test. RESULTS: The ONS group displayed significantly lower levels of prealbumin, albumin, hemoglobin, and BMI than the non-ONS group at admission. The incidence of malignant tumors, intestinal obstruction, and inflammatory bowel disease was significantly higher in the ONS group than the non-ONS group. The ONS group had a significantly higher effective rate than the non-ONS group (51.7% versus 50.3%, P < 0.05). Analysis of the decision-tree model revealed that the ONS group experienced an increase in cost of 19 850.96 yuan but achieved an additional 1.3406 effectiveness rate, resulting in an incremental cost-effectiveness ratio of 14 807.51, which fell below China's 2020 per capita gross domestic product of 71 965 yuan. Sensitivity analysis further confirmed the robustness of the model. CONCLUSIONS: ONS are demonstrated a high rate of efficacy, although patients currently using ONS are typically in a severe disease state. In addition, ONS is cost-effective. We suggest that the reimbursement coverage of ONS be expanded to include in-hospital patients who are at high nutritional risk.
Subject(s)
Cost-Benefit Analysis , Dietary Supplements , Hospitalization , Humans , China , Male , Dietary Supplements/economics , Female , Middle Aged , Hospitalization/statistics & numerical data , Hospitalization/economics , Aged , Adult , Administration, Oral , Treatment Outcome , Decision Trees , Propensity Score , Inpatients/statistics & numerical dataABSTRACT
OBJECTIVES: This systematic review aims to critically evaluate and synthesize the economic outcomes of various therapeutic strategies employed to manage cachexia patients. METHODS: A comprehensive search for randomized controlled trials and observational studies was conducted from January 1, 2000 to December 31, 2023, using PubMed, Google Scholar, Clinical Trials Registry, Cochrane Central Register of Controlled Trials, British Medical Journal, National Health Service Economic Evaluation Database, and ScienceDirect, following PRISMA guidelines. We assessed the quality of the included studies using the Consolidated Health Economic Evaluation Reporting Standards reporting guidelines. RESULTS: We identified six high to medium quality economic evaluations in four countries, focusing on cancer, chronic obstructive pulmonary disease, and HIV/AIDS-associated cachexia. The results indicate that combination management strategies, specifically the use of nutritional supplements and exercise, are more cost-effective than usual care for cachexia syndrome. Additionally, two studies showed that dietary supplements alone were more cost-effective than usual care, and pharmacotherapy alone was more cost-effective than a placebo. CONCLUSION: Combining several strategies, such as nutritional supplements and exercise, may be the most economically efficient method for managing cachexia compared to usual care or single treatment approaches. However, the restricted and diverse characteristics of the current research hinder the definitive conclusions.
Subject(s)
Cachexia , Cost-Benefit Analysis , Dietary Supplements , Humans , Cachexia/therapy , Cachexia/economics , Dietary Supplements/economics , Exercise Therapy/economics , Exercise Therapy/methods , Neoplasms/complications , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Disease, Chronic Obstructive/economics , Pulmonary Disease, Chronic Obstructive/complications , Randomized Controlled Trials as TopicABSTRACT
Antenatal multiple micronutrient supplementation (MMS) is an intervention that can help reach three of the six global nutrition targets, either directly or indirectly: a reduction in low birth weight, stunting, and anaemia in women of reproductive age. To support global guideline development and national decision-making on investments into maternal nutrition, Nutrition International developed a modelling tool called the MMS cost-benefit tool to help users understand whether antenatal MMS is better value for money than iron and folic acid supplementation (IFAS) during pregnancy. The MMS cost-benefit tool can generate estimates on the potential health impact, budget impact, economic value, cost-effectiveness and benefit-cost ratio of investing in MMS compared to IFAS in LMICs. In the 33 countries with data included in the tool, the MMS cost-benefit tool shows that transitioning is expected to generate substantial health benefits in terms of morbidity and mortality averted and can be very cost-effective in multiple scenarios for these countries. The cost per DALY averted averages at US$ 23.61 and benefit-cost ratio ranges from US$ 41-US$ 1304: $1.0, which suggest MMS is good value for money compared with IFAS. With its user-friendly design, open access availability, and online data-driven analytics, the MMS cost-benefit tool can be a powerful resource for governments and nutrition partners seeking timely and evidence-based analyses to inform policy-decision and investments towards the scale-up of MMS for pregnant women globally.
Subject(s)
Dietary Supplements , Micronutrients , Nutrition Policy , Micronutrients/economics , Nutrition Policy/economics , Humans , Female , Pregnancy , Dietary Supplements/economics , Cost-Benefit Analysis , Treatment OutcomeABSTRACT
BACKGROUND: Malnutrition among women of childbearing age is especially prevalent in Asia and sub-Saharan Africa and can be harmful to the fetus during pregnancy. In the most recently available Demographic and Health Survey (DHS), approximately 10% to 20% of pregnant women in India, Pakistan, Mali, and Tanzania were undernourished (body mass index [BMI] <18.5 kg/m2), and according to the Global Burden of Disease (GBD) 2017 study, approximately 20% of babies were born with low birth weight (LBW; <2,500 g) in India, Pakistan, and Mali and 8% in Tanzania. Supplementing pregnant women with micro and macronutrients during the antenatal period can improve birth outcomes. Recently, the World Health Organization (WHO) recommended antenatal multiple micronutrient supplementation (MMS) that includes iron and folic acid (IFA) in the context of rigorous research. Additionally, WHO recommends balanced energy protein (BEP) for undernourished populations. However, few studies have compared the cost-effectiveness of different supplementation regimens. We compared the cost-effectiveness of MMS and BEP with IFA to quantify their benefits in 4 countries with considerable prevalence of maternal undernutrition. METHODS AND FINDINGS: Using nationally representative estimates from the 2017 GBD study, we conducted an individual-based dynamic microsimulation of population cohorts from birth to 2 years of age in India, Pakistan, Mali, and Tanzania. We modeled the effect of maternal nutritional supplementation on infant birth weight, stunting and wasting using effect sizes from Cochrane systematic reviews and published literature. We used a payer's perspective and obtained costs of supplementation per pregnancy from the published literature. We compared disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (ICERs) in a baseline scenario with existing antenatal IFA coverage with scenarios where 90% of antenatal care (ANC) attendees receive either universal MMS, universal BEP, or MMS + targeted BEP (women with prepregnancy BMI <18.5 kg/m2 receive BEP containing MMS while women with BMI ≥18.5 kg/m2 receive MMS). We obtained 95% uncertainty intervals (UIs) for all outputs to represent parameter and stochastic uncertainty across 100 iterations of model runs. ICERs for all scenarios were lowest in Pakistan and greatest in Tanzania, in line with the baseline trend in prevalence of and attributable burden to LBW. MMS + targeted BEP averts more DALYs than universal MMS alone while remaining cost-effective. ICERs for universal MMS compared to baseline IFA were $52 (95% UI: $28 to $78) for Pakistan, $72 (95% UI: $37 to $118) for Mali, $70 (95% UI: $43 to $104) for India, and $253 (95% UI: $112 to $481) for Tanzania. ICERs for MMS + targeted BEP compared to baseline IFA were $54 (95% UI: $32 to $77) for Pakistan, $73 (95% UI: $40 to $104) for Mali, $83 (95% UI: $58 to $111) for India, and $245 (95% UI: $127 to $405) for Tanzania. Study limitations include generalizing experimental findings from the literature to our populations of interest and using population-level input parameters that may not reflect the heterogeneity of subpopulations. Additionally, our microsimulation fuses multiple sources of data and may be limited by data quality and availability. CONCLUSIONS: In this study, we observed that MMS + targeted BEP averts more DALYs and remains cost-effective compared to universal MMS. As countries consider using MMS in alignment with recent WHO guidelines, offering targeted BEP is a cost-effective strategy that can be considered concurrently to maximize benefits and synergize program implementation.
Subject(s)
Cost-Benefit Analysis/trends , Dietary Proteins/economics , Folic Acid/economics , Iron/economics , Micronutrients/economics , Prenatal Care/economics , Adolescent , Adult , Cohort Studies , Dietary Proteins/administration & dosage , Dietary Supplements/economics , Disability-Adjusted Life Years/trends , Energy Intake , Female , Folic Acid/administration & dosage , Humans , India/epidemiology , Infant, Newborn , Iron/administration & dosage , Male , Mali/epidemiology , Micronutrients/administration & dosage , Middle Aged , Pakistan/epidemiology , Pregnancy , Prenatal Care/trends , Tanzania/epidemiology , Young AdultABSTRACT
In this paper, we assess the cost-effectiveness of 1 g daily of carnosine (an over the counter supplement) in addition to standard care for the management of type 2 diabetes and compare it to standard care alone. Dynamic multistate life table models were constructed in order to estimate both clinical outcomes and costs of Australians aged 18 years and above with and without type 2 diabetes over a ten-year period, 2020 to 2029. The dynamic nature of the model allowed for population change over time (migration and deaths) and accounted for the development of new cases of diabetes. The three health states were 'Alive without type 2 diabetes', 'Alive with type 2 diabetes' and 'Dead'. Transition probabilities, costs, and utilities were obtained from published sources. The main outcome of interest was the incremental cost-effectiveness ratio (ICER) in terms of cost per year of life saved (YoLS) and cost per quality-adjusted life year (QALY) gained. Over the ten-year period, the addition of carnosine to standard care treatment resulted in ICERs (discounted) of AUD 34,836 per YoLS and AUD 43,270 per QALY gained. Assuming the commonly accepted willingness to pay threshold of AUD 50,000 per QALY gained, supplemental dietary carnosine may be a cost-effective treatment option for people with type 2 diabetes in Australia.
Subject(s)
Carnosine/administration & dosage , Carnosine/economics , Cost-Benefit Analysis/economics , Diabetes Mellitus, Type 2/drug therapy , Australia , Costs and Cost Analysis , Dietary Supplements/economics , Glycemic Control/economics , Glycemic Control/methods , Health Care Costs , HumansABSTRACT
BACKGROUND: This study aimed to evaluate the cost-effectiveness of vitamin D supplementation in preventing type 2 diabetes mellitus (T2DM) among Iranian adolescents. METHODS: This analytical observational study was conducted, using the decision tree model constructed in TreeAge Pro to assess the cost per quality-adjusted life-year (QALY) of monthly intake vitamin D supplements to prevent T2DM compared to no intervention from the viewpoint of Iran's Ministry of Health and through an one-year horizon. In the national program of vitamin D supplementation, 1,185,211 Iranian high-school students received 50,000 IU vitamin D supplements monthly for nine months. The costs-related data were modified to 2018. The average cost and effectiveness were compared based on the Incremental Cost-Effectiveness Ratio (ICER). RESULTS: Our analytical analysis estimated the 4071.25 (USD / QALY) cost per AQALY gained of the monthly intake of 50,000 IU vitamin D for nine months among adolescents over a one-year horizon. Based on the ICER threshold of 1032-2666, vitamin D supplementation was cost-effective for adolescents to prevent adulthood T2DM. It means that vitamin D supplementation costs were substantially less than the costs of T2DM treatments than the no intervention. CONCLUSIONS: Based on the findings, the national vitamin D supplementation program for Iranian adolescents could be a cost-effective strategy to reduce the risk of diabetes in adulthood. From an economic perspective, vitamin D supplementation, especially in adolescents with vitamin D deficiency, would be administrated.
Subject(s)
Diabetes Mellitus, Type 2/prevention & control , Dietary Supplements/economics , National Health Programs/economics , Vitamin D/administration & dosage , Adolescent , Diabetes Mellitus, Type 2/etiology , Humans , IranABSTRACT
BACKGROUND: In Pakistan, the prevalence of stunting among children younger than 5 y has remained above WHO critical thresholds (≥30%) over the past 2 decades. OBJECTIVES: We hypothesized that an unconditional cash transfer (UCT) combined with lipid-based nutrient supplement (LNS) and/or social and behavior change communication (SBCC) will prevent stunting among children 6-23 mo of age. METHODS: This was a 4-arm, community-based cluster randomized controlled trial conducted in the district of Rahim Yar Khan, Pakistan. A total of 1729 children (UCT, n = 434; UCT + SBCC, n = 433; UCT + LNS, n = 430; and UCT + LNS + SBCC, n = 432) were enrolled at 6 mo of age and measured monthly for 18 mo until the age of 24 mo. RESULTS: At 24 mo of age, children who received UCT + LNS [rate ratio (RR): 0.85; 95% CI: 0.74, 0.97; P = 0.015) and UCT + LNS + SBCC (RR: 0.86; 95% CI: 0.77, 0.96; P = 0.007) had a significantly lower risk of being stunted compared with the UCT arm. No significant difference was noted among children who received UCT + SBCC (RR: 1.03; 95% CI: 0.91, 1.16; P = 0.675) in the risk of being stunted compared with the UCT arm. The pooled prevalence of stunting among children aged 6-23 mo was 41.7%, 44.8%, 38.5%, and 39.3% in UCT, UCT + SBCC, UCT + LNS, and UCT + LNS + SBCC, respectively. In pairwise comparisons, a significant impact on stunting among children in UCT + LNS (P = 0.029) and UCT + LNS + SBCC (P = <0.001) was noted compared with the UCT arm. CONCLUSIONS: UCT combined with LNS and UCT + LNS + SBCC were effective in reducing the prevalence of stunting among children aged 6-23 mo in marginalized populations. UCT + SBCC was not effective in reducing the child stunting prevalence. This trial was registered at clinicaltrials.gov as NCT03299218.
Subject(s)
Behavior Therapy/methods , Dietary Supplements/economics , Feeding Behavior/psychology , Food Assistance/economics , Growth Disorders/prevention & control , Adult , Cluster Analysis , Female , Growth Disorders/epidemiology , Humans , Infant , Lipids/administration & dosage , Male , Pakistan/epidemiology , PrevalenceABSTRACT
The global market of food supplements is growing rapidly with a large turnover. Fish oil supplements represent a significant part of this turnover as they are believed to have important health benefits. Conversely, there are few papers in the literature about the quality control of fish oil capsules. As prior studies illustrate, a perfect agreement with the label is rarely found, and in some isolated cases, large amounts of soybean oil are also detected, indicating a true adulteration rather than a non-compliance with the label. None of the available studies refer to the Italian market, which ranks first in Europe in the consumption of food supplements. In this present communication, a quality control of fish-oil-based supplements from the Italian market was carried out for the first time. With minor deviations, all results showed substantial agreement with the label. However, the most important conclusion from this research is that compliance with the label is not enough to judge a product of good quality. The analysis of the overall fatty acid composition showed that some supplements have a high level of saturated fatty acids, and therefore they did not undergo a proper purification process. This may represent a safety issue since the purification process also allows the removal of toxic contaminants.
Subject(s)
Dietary Supplements/analysis , Dietary Supplements/economics , Fish Oils/analysis , Fish Oils/economics , Italy , Quality ControlABSTRACT
BACKGROUND: There is substantial increment in nutraceutical consumption in Nepal, although the data on its efficacy and safety is scarce. The practices of nutraceutical supplements users in Nepal remain undocumented. Therefore, this study was conducted to study the prescription pattern, cost, knowledge, attitude and practice (KAP) of the patient towards nutraceutical. METHODS: Descriptive cross-sectional study with stratified purposive sampling (n = 400) (patients from the out-patient departments of Scheer Memorial Adventist Hospital, Kavre, Nepal) was performed using a validated structured questionnaire assessing the socio-demographic characteristics, knowledge, attitude, practice of nutraceutical and total cost patients spent on nutraceutical alone. Pearson Chi-square test (x2) was used to investigate the association between socio-demographic variables and patients' KAP (knowledge, attitude and practice) towards nutraceutical. One way ANOVA was performed to compare the cost of nutraceutical among the different outpatient departments. RESULTS: More than 80% of patients were found to be consuming nutraceutical on their own. The mostly prescribed nutraceutical were vitamins (40.7%), minerals (23.7%), enzymes (21.1%), proteins (8.8%), probiotics (4.2%) and herbals (2.0%). With the most common reasons for consuming nutraceutical were to maintain good health (70.0%) and healthcare professionals (57.85%) were the most approached source of information for nutraceutical. Nearly half of the patients (46.5%) had an inadequate level of knowledge whereas more than two-third (71.5%) showed a moderate positive attitude towards nutraceutical use. The average amount patients spent was NRs.575.78 [equivalent to USD 4.85] per prescription on nutraceutical alone. The maximum cost amounted to NRs 757.18 [equivalent to USD 6.43] in Orthopedics, and the minimum cost was NRs 399.03 [equivalent to USD 3.36] in Obstetrics and gynecology, respectively. There was a significant difference (p <0.001) in cost of nutraceutical prescribed between the OPD clinics. CONCLUSION: The higher prevalence of inadequate knowledge despite moderate positive attitude towards nutraceutical among patients regarding some significant issues such as safety and interactions of nutraceutical consumption and its' substitution for meals reflects the need to develop an educational strategy to increase general public awareness on the rational use of nutraceutical.
Subject(s)
Dietary Supplements/statistics & numerical data , Health Knowledge, Attitudes, Practice , Patients/psychology , Adolescent , Adult , Costs and Cost Analysis , Dietary Supplements/economics , Drug Prescriptions/statistics & numerical data , Female , Hospitals/statistics & numerical data , Humans , Male , Middle Aged , NepalABSTRACT
BACKGROUND: The Dietary Approach to Stop Hypertension (DASH) and potassium supplementation have been shown to reduce the risk of death with a functioning graft (DWFG) and renal graft failure in renal transplant recipients (RTR). Unfortunately, a key problem for patients is the adherence to these diets. The aim of this study is to evaluate the cost-effectiveness and budget impact of higher adherence to either the DASH or potassium supplementation. METHODS: A Markov model was used to simulate the life course of 1000 RTR in the Netherlands. A societal perspective with a lifetime time horizon was used. The potential effect of improvement of dietary adherence was modelled in different scenarios. The primary outcomes are the incremental cost-effectiveness ratio (ICER) and the budget impact. RESULTS: In the base case, improved adherence to the DASH diet saved 27,934,786 and gained 1880 quality-adjusted life years (QALYs). Improved adherence to potassium supplementation saved 1,217,803 and gained 2901 QALYs. Both resulted in dominant ICERs. The budget impact over a five-year period for the entire Dutch RTR population was 8,144,693. CONCLUSION: Improving dietary adherence in RTR is likely to be cost-saving and highly likely to be cost-effective compared to the current standard of care in the Netherlands.
Subject(s)
Diet Therapy/economics , Dietary Approaches To Stop Hypertension/economics , Dietary Supplements/economics , Kidney Transplantation/rehabilitation , Potassium, Dietary/administration & dosage , Cost-Benefit Analysis , Diet Therapy/methods , Female , Humans , Male , Markov Chains , Middle Aged , Netherlands , Patient Compliance/statistics & numerical data , Quality-Adjusted Life YearsABSTRACT
OBJECTIVE: Patients requiring abdominal aortic aneurysm (AAA) repair are at risk of post-operative complications due to poor pre-operative state. Pre-habilitation describes the enhancement of functional capacity and tolerance to an upcoming physiological stressor, intended to reduce those complications. The ability to provide such an intervention (physical, pharmacological, nutritional, or psychosocial) between diagnosis and surgery is a growing interest, but its role in AAA repair is unclear. This paper aimed to systematically review existing literature to better describe the effect of pre-habilitative interventions on post-operative outcomes of patients undergoing AAA repair. DATA SOURCES: EMBASE and Medline were searched from inception to October 2020. Retrieved papers, systematic reviews, and trial registries were citation tracked. REVIEW METHODS: Randomised controlled trials (RCTs) comparing post-operative outcomes for adult patients undergoing a period of pre-habilitation prior to AAA repair (open or endovascular) were eligible for inclusion. Two authors screened titles for inclusion, assessed risk of bias, and extracted data. Primary outcomes were post-operative 30 day mortality, composite endpoint of 30 day post-operative complications, hospital length of stay (LOS), and health related quality of life (HRQL) outcomes. The content of interventions was extracted and a narrative analysis of results undertaken. RESULTS: Seven RCTs with 901 patients were included (three exercise based, two pharmacological based, and two nutritional based). Risk of bias was mostly unclear or high and the clinical heterogeneity between the trials precluded data pooling for meta-analyses. The quality of intervention descriptions was highly variable. One exercise based RCT reported significantly reduced hospital LOS and another improved HRQL outcomes. Neither pharmacological nor nutritional based RCTs reported significant differences in primary outcomes. CONCLUSION: There is limited evidence to draw clinically robust conclusions about the effect of pre-habilitation on post-operative outcomes following AAA repair. Well designed RCTs, adhering to reporting standards for intervention content and trial methods, are urgently needed to establish the clinical and cost effectiveness of pre-habilitation interventions.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/adverse effects , Postoperative Complications/prevention & control , Preoperative Care/methods , Aortic Aneurysm, Abdominal/economics , Aortic Aneurysm, Abdominal/mortality , Cost-Benefit Analysis/statistics & numerical data , Dietary Supplements/economics , Dietary Supplements/statistics & numerical data , Hospital Mortality , Human Growth Hormone/administration & dosage , Human Growth Hormone/economics , Humans , Length of Stay/statistics & numerical data , Postoperative Complications/economics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Preoperative Care/economics , Preoperative Care/statistics & numerical data , Preoperative Exercise , Quality of Life , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
The feeding experiment was conducted at Ofla district, southern Tigray, North Ethiopia, to investigate feed utilization, diet digestibility, and its economic feasibility under different supplementation options. Twenty-four yearling intact growing lambs were used in randomized complete block design with three treatments and eight replications. The treatment diets were T1 (molasses 15% + wheat bran 48% + cotton seed cake 35%), T2 (maize grain 20% + wheat bran 43% + noug seed cake 35%) and T3 (maize grain 20% + wheat bran 33% + dried brewers' grain 45%). The diet was formulated as iso-nitrogenous and each animal has taken daily nutrient requirements according to their body weight. The collected data were analyzed using SAS (2007) statistical software. Economic analysis was done using standard partial budget analysis guidelines of CIMMIT (1988). The crude protein contents of the three treatment rations were comparable across treatments. There was a higher total dry matter intake recorded in animals fed on T3 as compared to the other treatments. The barley straw intake was higher and significant (P < 0.05) for the animals' group in T3 than that of T1 and T2. Animals fed with T3 had significantly (P < 0.05) higher organic matter intake as compared to those fed with T1 and T2. However, there was no significant (P > 0.05) differences in crude protein intake between treatments. The apparent digestibility of dry matter, organic matter, and crude protein had no significant differences (P > 0.05) between treatments. Similarly, the apparent digestibility of neutral detergent fiber and acid detergent fiber was not significantly different (P > 0.05) among T1, T2, and T3. In general, animals that fed on T3 achieved better feed utilization and economic return as compared to the others.
Subject(s)
Animal Feed/analysis , Animal Husbandry/economics , Dietary Supplements/analysis , Digestion , Energy Metabolism , Sheep, Domestic/physiology , Animal Feed/economics , Animal Nutritional Physiological Phenomena , Animals , Diet/veterinary , Dietary Supplements/economics , Ethiopia , Male , Random AllocationABSTRACT
PURPOSE: The main objective of the present study was to investigate the attitudes among a sample of educated Greek consumers toward the use of dietary supplements (DS) and functional foods (FF) given that attitudes and behaviors as regards DS/FF have not been sufficiently evaluated in Southern Europe, where their penetration is lower as compared to northern countries. METHOD: An online questionnaire was completed by 358 individuals (n = 358, 55.6% females, 44.4% males, and 82% of the total with higher education). Questionnaire reliability was assessed by Cronbach's alpha coefficient while independence among qualitative variables was assayed by Pearson's chi-squared test or Fisher's exact test. The different groups of questions were analyzed by factor analysis, with principal component analysis and Varimax rotation, applied after a factor analysis and Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy test. Finally, a hierarchical cluster analysis based on Ward's method, using the squared Euclidean distance as a measure, was performed in order to identify and classify cases. RESULTS: Our results revealed that the majority of responders were aware of the principles of healthy eating, considering DS/FF as valid additives conferring beneficial effects. A surprising finding is that consumers, independently of the use of DS/FF, tend to prepare food at home and to adhere strongly to the Mediterranean diet and its principles. In addition, they express a certain degree of wariness as to product labeling and health claims, following instead the recommendations of health professionals and scientific evidence. Finally, they prefer to purchase DS/FF from pharmacies. CONCLUSION: Our findings provide valuable data concerning active Greek consumers' attitudes toward these relative new products, which could be extended to other Mediterranean and South European populations.
Subject(s)
Consumer Behavior , Dietary Supplements/economics , Functional Food/economics , Adult , Data Collection , Diet , Female , Greece , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
BACKGROUND: Home artificial nutrition (HAN) is an established treatment for malnourished patients. Since July 2012, the costs for oral nutrition supplements (ONS) are covered by the compulsory health insurance providers in Switzerland if the patient has a medical indication based on the Swiss Society for Clinical Nutrition guidelines. Therefore, the purpose of our study was to analyse the development of HAN, including ONS, before and after July 2012. METHODS: We obtained the retrospective and anonymized data from the Swiss association for joint tasks of health insurers (SVK), who registered patients on HAN. Since not all health insurers are working with SVK, this retrospective study recorded nearly 65% of all new patients on HAN in Switzerland from January 1, 2010, to December 31, 2015. RESULTS: A total of 33,410 patients (49.1% men and 50.9% women) with a mean BMI of 21.3 ± 4.5 kg/m2 and mean age of 68.9 ± 17.8 years were recorded. The number of patient cases on ONS increased from 808 cases in 2010 to 18,538 cases in 2015, while patient cases on home enteral nutrition (HEN) and home parenteral nutrition (HPN) remained approximately the same. The relative distribution of type of HAN changed from 26.2% cases on ONS, 68.7% cases on HEN and 5.1% cases on HPN in 2010 to 86.1% cases on ONS, 12.8% cases on HEN, and 1.1% cases on HPN in 2015. Treatment duration decreased for ONS from 698 ± 637 days to 171 ± 274 days, for HEN from 416 ± 553 days to 262 ± 459 days, and for HPN from 96 ± 206 days to 72 ± 123 days. Mean costs per patient decreased for ONS from 1,330 CHF in 2010 to 606 CHF in 2015. Total costs for HAN increased from 16,895,373 CHF in 2010 to 32,868,361 CHF in 2015. CONCLUSION: Our epidemiological follow-up study showed an immense increase in number of patients on HAN in Switzerland after July 2012. Due to shorter therapy duration and reduced mean costs per patient, total costs were only doubled while the number of patients increased 7-fold.
Subject(s)
Dietary Supplements/statistics & numerical data , Health Care Costs/trends , Insurance, Health/trends , Nutrition Policy/trends , Parenteral Nutrition, Home/statistics & numerical data , Aged , Dietary Supplements/economics , Dietary Supplements/standards , Enteral Nutrition/economics , Enteral Nutrition/standards , Enteral Nutrition/statistics & numerical data , Female , Follow-Up Studies , Humans , Male , Middle Aged , Nutrition Policy/economics , Parenteral Nutrition, Home/economics , Parenteral Nutrition, Home/standards , Retrospective Studies , Switzerland , Time FactorsABSTRACT
Nile tilapia, Oreochromis niloticus is the third most commonly farmed finfish species in the world, accounting for nearly 5% of global aquaculture production. In the past few decades much of the success of this species has been attributed to the development and distribution of Genetically Improved Farmed Tilapia (GIFT). Despite the increasing availability of GIFT, the productivity of small-scale farming remains highly variable, particularly in developing nations. Commercial fish-feed pellets can increase fish farm productivity; however, many small-scale farmers rely on other means of feeding fish due to the high cost and limited availability of commercial fish feed pellets. Therefore, understanding how locally-sourced feeds affect the production of GIFT is an important step towards improving feeding practices, particularly for farmers with low financial capital. This study used stable isotope analysis (SIA) and 16S rRNA gene sequencing to compare the effects of a locally-sourced vegetable-based diet and commercial pellet-based diets on the relative condition, nutrient assimilation patterns and gastrointestinal microbiota of GIFT. GIFT fed a locally-sourced diet were smaller, and in a significantly poorer condition than those fed with commercial fish feeds. SIA showed no differences in dietary carbon between the two diets; however, δ13C, poor fish condition and the abundance of specific bacterial taxa (of such as Fusobacteria) were correlated. SIA revealed that GIFT fed locally-sourced diets that predominantly consisted of vegetables were significantly enriched in δ15N despite a perceived lack of dietary protein. This enrichment suggests that GIFT fed a locally-sourced diet may be supplementing their diet via cannibalism, a behaviour representative of poor farming practice. Overall this study highlights the need to increase the availability of suitable GIFT feeds in developing nations. The development a low-cost feed alternative could improve the success of small-scale GIFT farmers in PNG, increasing both food and income security within the region.
Subject(s)
Animal Feed , Animals, Genetically Modified/metabolism , Aquaculture/methods , Cichlids/metabolism , Gastrointestinal Microbiome/physiology , Animals , Animals, Genetically Modified/genetics , Animals, Genetically Modified/microbiology , Aquaculture/economics , Aquaculture/organization & administration , Cannibalism , Cichlids/genetics , Cichlids/microbiology , DNA, Bacterial/isolation & purification , Dietary Supplements/economics , Efficiency, Organizational/economics , Farms/economics , Farms/organization & administration , New South Wales , Nutrients/metabolism , RNA, Ribosomal, 16S/geneticsABSTRACT
BACKGROUND: Universal home fortification of complementary foods with iron-containing multiple micronutrient powders (MNPs) is a key intervention to prevent anaemia in young children in low-income and middle-income countries. However, evidence that MNPs might promote infection raises uncertainty about whether MNPs give net health benefits and are cost-effective. We aimed to determined country-specific net benefit or harm and cost-effectiveness of universal provision of MNPs to children aged 6 months. METHODS: We developed a microsimulation model to estimate net country-specific disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to anaemia, malaria, and diarrhoea averted (or increased) by provision of a 6-month course of MNPs to children aged 6 months, compared with no intervention, who would be followed up for an additional 6 months (ie, to age 18 months). Anaemia prevalence was derived from Demographic and Health Surveys or similar national surveys, and malaria and diarrhoea incidence were sourced from the Global Burden of Disease Study. Programme and health-care costs were modelled to determine cost per DALY averted (US$). Additionally, we explored the effects of reduced MNP coverage in a sensitivity analysis. FINDINGS: 78 countries (46 countries in Africa, 20 in Asia or the Middle East, and 12 in Latin America) were included in the analysis, and we simulated 5 million children per country. 6 months of universal distribution of daily MNPs, assuming 100% coverage, produced a net benefit (DALYs averted) in 54 countries (24 in Africa, 19 in Asia and the Middle East, 11 in Latin America) and net harm in 24 countries (22 in Africa, one in Asia, and one in Latin America). MNP intervention provided a benefit on YLDs associated with anaemia, but these gains were attenuated and sometimes reversed by increases in YLLs associated with malaria and diarrhoea, reducing the benefits seen for DALYs. In the 54 countries where MNP provision was beneficial, the median benefit was 28·1 DALYs averted per 10â000 children receiving MNPs (IQR 20·6-40·4), and median cost per DALY averted was $3576 (IQR 2474-4918). DALY effects positively correlated with moderate and severe anaemia prevalence in Asia, the Middle East, and Latin America, but correlated inversely in Africa. Suboptimal coverage markedly reduced DALYs averted and cost-effectiveness. INTERPRETATION: Net health benefits of MNPs vary between countries, are highest where prevalence of moderate and severe anaemia is greatest but infection prevalence is smallest, and are ameliorated when coverage of the intervention is poor. Our data provide country-specific guidance to national policy makers. FUNDING: International Union of Nutrition Sciences.
Subject(s)
Anemia/prevention & control , Developing Countries , Dietary Supplements , Iron, Dietary/economics , Iron, Dietary/therapeutic use , Micronutrients/economics , Micronutrients/therapeutic use , Cost-Benefit Analysis , Dietary Supplements/economics , Humans , Infant , Powders , Treatment OutcomeABSTRACT
This study aimed to evaluate different scenarios (year, supplementation level) about economic results of beef cattle production during rearing and finishing phase in Brazilian's tropical pastures. Four scenarios were evaluated in combination with fourteen supplements, and it was originated from some research developed inside Forage Crops and Grasslands section from São Paulo State University among years 2011 and 2014. The economic evaluation was analyzed by operating cost, total operational costs, gross revenue, operating profit, and financial net income. Besides profitability, internal rate of return (IRR), benefit/cost ratio (B:C), and simple payback period (SPP) were calculated too. During rearing phase, the best result was observed for scenario 2 (2012), supplement 3.2 (mineral mix) with values of 11 cycles, 26.3%, 9.30%, and 0.39 for SPP, profitability, IRR, and B:C ratio, respectively. Already to finishing phase, the best scenario was 3 (2013), supplement 10 (multiple supplement with supplementation level equal 1.0% body weight), which obtained 4 cycles, 68.7%, 27.00%, and 2.34 for the same variables above mentioned. Results were consistent being that higher IRR and profitability occurred when using low supplementation level. Hence, the economic responses from different scenarios (years and supplements) can alter the final livestock farm financial statement.
Subject(s)
Animal Feed/economics , Animal Husbandry/economics , Cattle , Cost-Benefit Analysis , Diet/veterinary , Dietary Supplements/economics , Animal Feed/analysis , Animals , Body Weight , Brazil , Diet/economics , Dietary Supplements/analysisABSTRACT
A bibliographic database of scientific papers published by authors affiliated to research institutions worldwide, especially focused in Europe and in the European Atlantic Area, and containing the keywords "microalga(e)" or "phytoplankton" was built. A corpus of 79,020 publications was obtained and analyzed using the Orbit Intellixir software to characterize the research trends related to microalgae markets, markets opportunities and technologies that could have important impacts on markets evolution. Six major markets opportunities, the production of biofuels, bioplastics, biofertilizers, nutraceuticals, pharmaceuticals and cosmetics, and two fast-evolving technological domains driving markets evolution, microalgae harvesting and extraction technologies and production of genetically modified (GM-)microalgae, were highlighted. We here present an advanced analysis of these research domains to give an updated overview of scientific concepts driving microalgae markets.