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A systematic review of the cost and cost-effectiveness of standard oral nutritional supplements in the hospital setting

A systematic review of the cost and cost-effectiveness of standard oral nutritional supplements in the hospital setting
A systematic review of the cost and cost-effectiveness of standard oral nutritional supplements in the hospital setting
Background & aims: there is limited information about the economic impact of nutritional support despite its known clinical benefits. This systematic review examined the cost and cost-effectiveness of standard (non-disease specific) oral nutritional supplements (ONS) administered in the hospital setting only.

Methods: a systematic literature search of multiple databases, data synthesis and analysis were undertaken according to recommended procedures.

Results: nine publications comprising four full text papers, two abstracts and three reports, one of which contained 11 cost analyses of controlled cohort studies, were identified. Most of these were based on retrospective analyses of randomised controlled trials designed to assess clinically relevant outcomes. The sample sizes of patients with surgical, orthopaedic and medical problems and combinations of these varied from 40 to 1.16 million. Of 14 cost analyses comparing ONS with no ONS (or routine care), 12 favoured the ONS group, and among those with quantitative data (12 studies) the mean cost-saving was 12.2%. In a meta-analysis of five abdominal surgical studies in the UK, the mean net cost saving was £772 per patient (se £346; P = 0.026). Cost savings were typically associated with significantly improved outcomes, demonstrated through the following meta-analyses: reduced mortality (Risk ratio 0.650, P < 0.05; N = 5 studies), reduced complications (by 35% of the total; P < 0.001, N = 6 studies) and reduced length of hospital stay (by 2 days, P < 0.05; N = 6 surgical studies). Two studies also found ONS to be cost-effective, one by avoiding development of pressure ulcers and releasing hospital beds, and the other by gaining quality adjusted life years.

Conclusion: this review suggests that standard ONS in the hospital setting produce a cost-saving and are cost-effective. The evidence base could be further strengthened by prospective studies in which the primary outcome measures are economic
oral nutritional supplements, malnutrition, cost, cost-effectiveness, systematic review, hospital
0261-5614
1-11
Elia, M.
964bf436-e623-46d6-bc3f-5dd04c9ef4c1
Normand, C.
f8307c24-2875-4b85-89f6-c356dee0cba0
Norman, K.
c606ff72-f796-4267-83cb-3b46154ca7b4
Laviano, A.
e6ffc850-a84c-4b58-a6b0-bdf43e1261dc
Elia, M.
964bf436-e623-46d6-bc3f-5dd04c9ef4c1
Normand, C.
f8307c24-2875-4b85-89f6-c356dee0cba0
Norman, K.
c606ff72-f796-4267-83cb-3b46154ca7b4
Laviano, A.
e6ffc850-a84c-4b58-a6b0-bdf43e1261dc

Elia, M., Normand, C., Norman, K. and Laviano, A. (2015) A systematic review of the cost and cost-effectiveness of standard oral nutritional supplements in the hospital setting. Clinical Nutrition, 1-11. (doi:10.1016/j.clnu.2015.05.010).

Record type: Article

Abstract

Background & aims: there is limited information about the economic impact of nutritional support despite its known clinical benefits. This systematic review examined the cost and cost-effectiveness of standard (non-disease specific) oral nutritional supplements (ONS) administered in the hospital setting only.

Methods: a systematic literature search of multiple databases, data synthesis and analysis were undertaken according to recommended procedures.

Results: nine publications comprising four full text papers, two abstracts and three reports, one of which contained 11 cost analyses of controlled cohort studies, were identified. Most of these were based on retrospective analyses of randomised controlled trials designed to assess clinically relevant outcomes. The sample sizes of patients with surgical, orthopaedic and medical problems and combinations of these varied from 40 to 1.16 million. Of 14 cost analyses comparing ONS with no ONS (or routine care), 12 favoured the ONS group, and among those with quantitative data (12 studies) the mean cost-saving was 12.2%. In a meta-analysis of five abdominal surgical studies in the UK, the mean net cost saving was £772 per patient (se £346; P = 0.026). Cost savings were typically associated with significantly improved outcomes, demonstrated through the following meta-analyses: reduced mortality (Risk ratio 0.650, P < 0.05; N = 5 studies), reduced complications (by 35% of the total; P < 0.001, N = 6 studies) and reduced length of hospital stay (by 2 days, P < 0.05; N = 6 surgical studies). Two studies also found ONS to be cost-effective, one by avoiding development of pressure ulcers and releasing hospital beds, and the other by gaining quality adjusted life years.

Conclusion: this review suggests that standard ONS in the hospital setting produce a cost-saving and are cost-effective. The evidence base could be further strengthened by prospective studies in which the primary outcome measures are economic

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More information

Accepted/In Press date: 16 May 2015
e-pub ahead of print date: 29 May 2015
Keywords: oral nutritional supplements, malnutrition, cost, cost-effectiveness, systematic review, hospital
Organisations: NIHR Southampton Biomedical Research Centre

Identifiers

Local EPrints ID: 377657
URI: http://eprints.soton.ac.uk/id/eprint/377657
ISSN: 0261-5614
PURE UUID: 32c45776-d776-4ed1-93c6-c3fbec68a868

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Date deposited: 22 Jun 2015 10:19
Last modified: 14 Mar 2024 20:08

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Contributors

Author: M. Elia
Author: C. Normand
Author: K. Norman
Author: A. Laviano

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