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A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings

A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings
A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings
Background & aims

Despite the clinical benefits of using standard (non-disease specific) oral nutritional supplements (ONS) in the community and care homes, there is uncertainty about their economic consequences.

Methods

A systematic review was undertaken according to recommended procedures to assess whether ONS can produce cost savings and cost-effective outcomes.

Results

19 publications with and without a hospital component were identified: 9 full text papers, 9 abstracts, and 1 report with retrospective analyses of 6 randomised controlled trials. From these publications a total of 31 cost and 4 cost-effectiveness analyses were identified. Most were retrospective analyses based on clinical data from randomised controlled trials (RCTs). In 9 studies/economic models involving ONS use for <3 months, there were consistent cost savings compared to the control group (median cost saving 9.2%; P < 0.01). When used for ?3 months, the median cost saving was 5% (P > 0.05; 5 studies). In RCTs, ONS accounted for less than 5% of the total costs and the investment in the community produced a cost saving in hospital. Meta-analysis indicated that ONS reduced hospitalisation significantly (16.5%; P < 0.001; 9 comparisons) and mortality non-significantly (Relative risk 0.86 (95% CI, 0.61, 1.22); 8 comparisons). Many clinically relevant outcomes favouring ONS were reported: improved quality of life, reduced infections, reduced minor post-operative complications, reduced falls, and functional limitations. Of the cost-effectiveness analyses involving quality adjusted life years or functional limitations, most favoured the ONS group. The care home studies (4 cost analyses; 2 cost-effectiveness analyses) had differing aims, designs and conclusions.

Conclusions

Overall, the reviewed studies, mostly based on retrospective cost analyses, indicate that ONS use in the community produce an overall cost advantage or near neutral balance, often in association with clinically relevant outcomes, suggesting cost effectiveness. There is a need for prospective studies designed to examine primary economic outcomes.
oral nutritional supplements, malnutrition, cost, cost effectiveness, systematic review, community
0261-5614
1-13
Elia, M.
964bf436-e623-46d6-bc3f-5dd04c9ef4c1
Normand, C.
f8307c24-2875-4b85-89f6-c356dee0cba0
Laviano, A.
e6ffc850-a84c-4b58-a6b0-bdf43e1261dc
Norman, K.
c606ff72-f796-4267-83cb-3b46154ca7b4
Elia, M.
964bf436-e623-46d6-bc3f-5dd04c9ef4c1
Normand, C.
f8307c24-2875-4b85-89f6-c356dee0cba0
Laviano, A.
e6ffc850-a84c-4b58-a6b0-bdf43e1261dc
Norman, K.
c606ff72-f796-4267-83cb-3b46154ca7b4

Elia, M., Normand, C., Laviano, A. and Norman, K. (2015) A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings. Clinical Nutrition, 1-13. (doi:10.1016/j.clnu.2015.07.012). (PMID:26309240)

Record type: Article

Abstract

Background & aims

Despite the clinical benefits of using standard (non-disease specific) oral nutritional supplements (ONS) in the community and care homes, there is uncertainty about their economic consequences.

Methods

A systematic review was undertaken according to recommended procedures to assess whether ONS can produce cost savings and cost-effective outcomes.

Results

19 publications with and without a hospital component were identified: 9 full text papers, 9 abstracts, and 1 report with retrospective analyses of 6 randomised controlled trials. From these publications a total of 31 cost and 4 cost-effectiveness analyses were identified. Most were retrospective analyses based on clinical data from randomised controlled trials (RCTs). In 9 studies/economic models involving ONS use for <3 months, there were consistent cost savings compared to the control group (median cost saving 9.2%; P < 0.01). When used for ?3 months, the median cost saving was 5% (P > 0.05; 5 studies). In RCTs, ONS accounted for less than 5% of the total costs and the investment in the community produced a cost saving in hospital. Meta-analysis indicated that ONS reduced hospitalisation significantly (16.5%; P < 0.001; 9 comparisons) and mortality non-significantly (Relative risk 0.86 (95% CI, 0.61, 1.22); 8 comparisons). Many clinically relevant outcomes favouring ONS were reported: improved quality of life, reduced infections, reduced minor post-operative complications, reduced falls, and functional limitations. Of the cost-effectiveness analyses involving quality adjusted life years or functional limitations, most favoured the ONS group. The care home studies (4 cost analyses; 2 cost-effectiveness analyses) had differing aims, designs and conclusions.

Conclusions

Overall, the reviewed studies, mostly based on retrospective cost analyses, indicate that ONS use in the community produce an overall cost advantage or near neutral balance, often in association with clinically relevant outcomes, suggesting cost effectiveness. There is a need for prospective studies designed to examine primary economic outcomes.

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Elia_A_Systematic.pdf - Accepted Manuscript
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More information

Accepted/In Press date: 13 July 2015
e-pub ahead of print date: 30 July 2015
Keywords: oral nutritional supplements, malnutrition, cost, cost effectiveness, systematic review, community
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 382858
URI: http://eprints.soton.ac.uk/id/eprint/382858
ISSN: 0261-5614
PURE UUID: 5eb875a2-1b84-49fb-be49-cb8cd6164ff2

Catalogue record

Date deposited: 21 Oct 2015 13:14
Last modified: 16 Dec 2019 20:13

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Contributors

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

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