Economic Evaluation of Individualized Nutritional Support for Hospitalized Patients with Chronic Heart Failure

Round 1

Reviewer 1 Report

This is a retrospective study regarding the cost-effectiveness analysis of individualized nutritional support in hospitalized patients with HF suing the data of RCT (EFFORT study). As the already published findings of EFFORT study, nutritional support  lowered 180-day mortality. The Authors calculated cost-effectiveness ratio for nutritional support vs. control was 2,625 SF per life day. The Authors concluded that nutritional support was effective with acceptable cost-effective ratio.

Major comments:

1. Presented data were mostly cost-effective analysis. But cost-effectiveness is based on the beneficial/harmful effect of nutritional support on clinical outcome (events, complications, ADLs or length of hospital stay etc.). The Authors need to show these basal data related to cost-effectiveness analysis. First of all, how many patients were allocated to each group? And, for example, how many days did nutritional support group/no nutritional support group stay within each health state in the Markov model? How were those data extracted from the raw data? The Reviewer assumes that a part of these data are shown in Table 2a. But it is hard to interpret and the Authors need to show them so that the readers can easily understand.

2. The Authors stated that 100000SF per life year was set as a threshold of cost-effectiveness. Please explain why ICER 2625 SF per life day was acceptable. How was this threshold defined?

3. Table 2 is confusing. What does “Utilities (QALDs) mean? The Reviewer assumes that “Life days” might correctly mean “QALD”, rather.

4. Introduction is redundant. Especially, most of the first paragraph can be omitted.

Minor comments:

Line 137. Myocardial or cerebral  “infarction”?

Table 2a. The Reviewer cannot see the right side of the Table.  

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors present an economic evaluation of individualized nutritional support for hospitalized patients with chronic heart failure. This is an extremely interesting study since it analysis an easy-to-implement strategy to improve outcomes. The manuscript is very well written and easy to read. I have some comments:

- According to the authors, EFFORT included 645 patients with CHF, with 234 (36%) acutely 124 decompensated and 411 (64%) chronic stable HF. Did the economic analysis yield different results in patients with acutely decompensated HF than those with CHF?

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Thank you for the amendement suggested by the Reviewer. No further comments.