Cost-Effectiveness of a Specialized Oral Nutritional Supplementation for Malnourished Older Adult Patients in Spain

Abstract

Malnutrition has been related to prolonged hospital stays, and to increases in readmission and mortality rates. In the NOURISH (Nutrition effect On Unplanned Readmissions and Survival in Hospitalized patients) study, administering a high protein oral nutritional supplement (ONS) containing beta-hydroxy-beta-methylbutyrate (HP-HMB) to hospitalised older adult patients led to a significant improvement in survival compared with a placebo treatment. The aim of this study was to determine whether HP-HMB would be cost-effective in Spain. We performed a cost-effectiveness analysis from the perspective of the Spanish National Health System using time horizons of 90 days, 180 days, 1 year, 2 years, 5 years and lifetime. The difference in cost between patients treated with HP-HMB and placebo was €332.75. With the 90 days time horizon, the difference in life years gained (LYG) between both groups was 0.0096, resulting in an incremental cost-effectiveness ratio (ICER) of €34,700.62/LYG. With time horizons of 180 days, 1 year, 2 years, 5 years and lifetime, the respective ICERs were €13,711.68, €3377.96, €2253.32, €1127.34 and €563.84/LYG. This analysis suggests that administering HP-HMB to older adult patients admitted to Spanish hospitals during hospitalisation and after discharge could be a cost-effective intervention that would improve survival with a reduced marginal cost.

Comparison of two malnutrition risk screening tools with nutritional biochemical parameters, BMI and length of stay in Chinese geriatric inpatients: a multicenter, cross-sectional study

“… 7 8 These outcomes contribute to large increases in medical expenditures. 9 Early identification and treatment of malnutrition can lead to better quality of life 10 and improved outcomes 11 in older inpatients. Therefore, it is essential that appropriate tools are applied when assessing the risk of malnutrition in geriatric patients.…”

Economic evaluation of individualized nutritional support in medical inpatients: Secondary analysis of the EFFORT trial

“…For example, they do not account for past occurrences and require that patients transitioning from one to another health state would need to spend at least one cycle within the new health state before moving into another state. Additionally, no cost per QALY or life year gained values were calculated due to shorter-term effects measured within the EFFORT trial as compared with previous nutrition studies that assessed outcomes over longer periods of time [22,24,25]. However, these studies do support the long-term cost-effectiveness of similar nutrition support programs to the ones studied in our trial.…”

Cost-effectiveness analysis of oral nutritional supplements with nutritional counselling in head and neck cancer patients undergoing radiotherapy

“…However, we know little about its economic consequences, whose profile is often tied to the type of healthcare setting, nutritional intervention and patients’ group [ 34 ]. Economic evaluations of ONS have been conducted in older malnourished hospitalized patients in the USA [ 35 ], the Netherlands [ 36 ] and Spain [ 37 ], admitted with benign gastrointestinal disease [ 38 ], hip fracture [ 39 ] or for lower gastrointestinal tract surgery [ 40 ].…”