Cost-Effectiveness Evaluation of Incorporating oral Nutritional Support into the Explicit Health Guarantees package for patients with End-Stage Renal Disease on Hemodialysis in Chile

Introduction: End-stage renal disease represents a growing burden on the Chilean healthcare system. Protein energy wasting in patients on hemodialysisis highly prevalent and is associated with increased morbidity and mortality and healthcare costs. Despite clinical recommendations, oral nutritional support is not included in the Explicit Health Guarantees package. Objective: To evaluate the projected cost-effectiveness of incorporating oral nutritional support as part of the Explicit Health Guarantees package for patients with End-stage renal disease on hemodialysis in Chile. Methods: A projective economic study was conducted from the perspective of the healthcare system, using national information on the prevalence of End-stage renal disease, hospitalization costs, oral nutritional support prices, and clinical parameters from the literature. The incremental cost per Quality-Adjusted Life Yeargained was calculated, and savings from reduced hospitalizations were estimated. Time horizon: 5 years. Results: The implementation of oral nutritional support allow for a 20% reduction in hospitalizations attributable to malnutrition, with cumulative savings of Chilean Peso $4.362 billion and a release of 18.645 bed-days. The incremental cost per Quality-Adjusted Life Yearwas Chilean Peso $3.200.000, which is below the Chilean cost-effectiveness threshold. Conclusions: Incorporating oral nutritional support into the Explicit Health Guarantees package is a cost-effective, clinically beneficial, and viable intervention in the context of the Chilean health system. Its adoption is recommended as part of the comprehensive strategy for managing End-stage renal disease.