The Cost Effectiveness of Oral Nutrition Supplementation for Malnourished Older Hospital Patients

Abstract

Background Malnutrition, which is associated with increased medical complications in older hospitalized patients, can be attenuated by providing nutritional supplements. Objective This study evaluates the cost effectiveness of a specialized oral nutritional supplement (ONS) in malnourished older hospitalized patients. Methods We conducted an economic evaluation alongside a multicenter, randomized, controlled clinical trial (NOURISH Study). The target population was malnourished older hospitalized patients in the USA. We used 90-day (base case) and lifetime (sensitivity analysis) time horizons. The study compared a nutrient-dense ONS, containing high protein and b-hydroxy-b-methylbutyrate to placebo. Outcomes included health-care costs, measured as the product of resource use and per unit cost; quality-adjusted life-years (QALYs) (90-day time horizon); life-years (LYs) saved (lifetime time horizon); and the incremental cost-effectiveness ratio (ICER). All costs were inflated to 2015 US dollars. Results In the base-case analysis, 90-day treatment group costs averaged US$22,506 per person, compared to US$22,133 for the control group. Treatment group patients gained 0.011 more QALYs than control group subjects, reflecting the treatment group's significantly greater probability of survival through 90 days' follow-up, as reported by the clinical trial. Hence, the 90-day follow-up period ICER was US$33,818/QALY. Assuming a lifetime time horizon, estimated treatment group life expectancy exceeded control group life expectancy by 0.71 years. Hence, the lifetime ICER was US$524/LY. The follow-up period for the trial was relatively short. Some of the patients were lost to follow-up, thus reducing collection of health-care utilization data during the clinical trial. Conclusion Our findings suggest that the investigative ONS cost-effectively extends the lives of malnourished hospitalized patients.

Value of Nutrition Support Therapy: Impact on Clinical and Economic Outcomes in the United States

“…Based on these findings, 8 TAs with the best-quality evidence were selected for further analysis, as prioritized by points on rubric scores (Table 3). They included cross-disease malnutrition, 7,24-33 sepsis, 27,34-41 surgical complications, [42][43][44][45][46][47][48][49][50] HACs, [51][52][53][54][55][56][57][58] congestive heart failure, 9,[59][60][61][62][63][64][65][66][67][68] COPD, 8,9,16,[69][70][71][72][73] GI cancer, [74][75][76][77][78][79][80][81][82] and pancreatitis. [83][84][85]…”

Herausforderungen und Wirksamkeit eines klinischen Ernährungsteams

“…Die Früherkennung eines beeinträchtigten Ernährungszustands ist unabdingbar, um eine effektive Ernährungstherapie recht-zeitig einzuleiten. In den letzten Jahren konnten mehrere Studien den ökonomischen Vorteil der Ernährungstherapie aufzeigen [9][10][11].…”

Meeting the nutritional needs of older patients in the hospital setting

“…In addition, malnutrition can lead to a decline in functional status, decrease in muscle and bone mass, impaired immune function, anaemia, decline in cognitive ability, poor wound healing, delayed recovery from surgery and higher hospital re-admission rates (Ahmed and Haboubi, 2010). It is also associated with increased health care utilisation, costs, institutionalisation, mortality and has been shown to predict discharge destination (Zhong et al, 2017;O'Shea et al, 2017;Rasheed and Woods, 2013).…”