Researchers at the University of Southampton compared the cost-effective merits of oral nutritional supplements (ONS) compared to diet, surveying 104 care home residents over the age of 88.
Disease-related malnutrition (DRM) is a condition in which malnutrition can cause or result from disease and is costly and common.
In care homes, DRM predisposes residents to infections, ulcers and a greater number of days in bed, which has a detrimental impact on quality of life (QoL), says the study.
This is particularly acute in older population groups because the prevalence of malnutrition generally increase with age.
Those in the study were recruited from care homes in Hampshire, England between 2007 and 2010, suffering from mainly cardiovascular and neurological diseases but not suffering from overt dementia.
They were randomised to receive between 1.5-2.4 kilocalorie/millilitre of supplements or dietary advice to eat high energy and protein-filled foods, snacks and drinks for a 12-week period.
Evaluating costs of those involved in the study, says its authors, was crucial as cost was fundamental to the overall aim of the study.
Cost included not only dietetic costs and the costs of supplements to be consumed by residents but also the costs of visits to GPs, district and practice nurses and hospital admissions during the study period.
The health benefits were measured as the number of QALYs (quality adjusted life years) during the trial period while the probability that the supplements intervention was cost-effective was tested against two thresholds (€22,500 and €34,000 per QALY gained).
These figures corresponded to the lower and upper values of the range of what the UK’s healthcare rationing body NICE would be likely to pay.
More health benefits for those taking supplements
The results showed that although expenditure in the group taking supplements was greater than in the dietary advice groups (mainly due to the cost of supplements), the group taking supplements produced more health benefits, measured in QALYs.
The mean cost per QALY was found to be €11,150 which is below the NICE threshold, and is generally seen within the cost of what health care providers would be willing to pay.
Study author Marinos Elia, professor of clinical nutrition and metabolism, medicine, University of Southampton, said: “In summary, this cost-utility analysis involving one of the oldest age groups of malnourished people participating in a randomised pragmatic trial suggests that use of ready-made ONS in care home residents can produce a cost-effective outcome relative to dietary advice”
“These results can be used to highlight to payers and other health and social care decision makers the cost effectiveness of oral nutritional supplements, so that informed choices can be made about which treatments to use and/or fund.”
Published online ahead of print: doi: 10.1016/j.clnu.2017.02.008
“Cost-effectiveness of oral nutritional supplements in older malnourished care home residents.”
Authors: Marinos Elia, Emma Parsons, Rebecca Stratton et al