Sensitivity analyses with stratification for nutritional status showed that the cost-effectiveness for weight as outcome

was especially high in malnourished patients but also (Epacadostat concentration though slightly less high) in well-nourished patients. If selleck kinase inhibitor the nutritional intervention would be targeted to elderly patients (≥75 years), the probability that the intervention was cost-effective was also high. This was in marked contrast with younger patients (55–74 years), where cost effectiveness was <50%, possibly due to the fact that younger patients generally have a better general condition than elderly patients, so that nutritional intervention will have less effect on their weight. With respect to QALY, the probability for the intervention to be cost-effective was relatively low for the total population and subgroups; however, the probability that the nutritional intervention was cost-effective with respect to QALY was highest (60–90% depending on willingness to pay) in younger patients (55–74 years). Our results confirm previous studies indicating that the costs of nutritional intervention are extremely low (in our case, less than 3%) compared with regular health care costs such as hospital

costs [20, 22–24, 43, 44]. Previous research in malnourished patients living in the community and in a heterogeneous group of malnourished patients admitted to a mixed medical and surgical ward indicated that nutritional intervention with oral nutritional Emricasan ic50 supplementation alone or combined with dietetic counseling was cost-effective with regard to length PRKD3 of stay [24]. We found that, in hip fracture patients, the probability of the nutritional intervention to be cost-effective with regard to QALY as outcome was relatively low in the older age group of ≥75 years. Of note, older patients more often live in nursing homes even before the fracture, and

they tend to have more co-morbidities for which medical treatment is needed; both these factors may overrule the potential cost-reduction induced by the nutritional intervention. Also, after hip fracture, older and malnourished patients may have more postoperative complications and hospital re-admissions as compared with younger and well-nourished patients. As also noted in the literature, medical costs do not seem to be associated with the type of surgical procedure but are mainly determined by increasing age, living in an institution and the presence of co morbidity [21, 38, 41]. Finally, home-dwelling older patients often live alone, which may also result in a higher requirement of professional care as compared with patients living with their partner.