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Cost-effectiveness of oral nutritional supplements in older malnourished care home residents

Cost-effectiveness of oral nutritional supplements in older malnourished care home residents
Cost-effectiveness of oral nutritional supplements in older malnourished care home residents
BACKGROUND & AIMS: Malnutrition is common in care home residents, but information on the cost-effectiveness of nutritional interventions is lacking. This study, involving a randomised trial in care home residents, aimed to examine whether oral nutritional supplements (ONS) are cost-effective relative to dietary advice. METHODS: An incremental cost-effectiveness analysis was undertaken prospectively in 104 older care home residents (88 ± 8 years) without overt dementia, who were randomised to receive either ONS or dietary advice for 12 weeks. Costs were estimated from resource use and quality adjusted life years (QALYs) from health-related quality of life, assessed using EuroQoL (EQ-5D-3L, time-trade-off) and mortality. The incremental cost-effectiveness ratio (ICER) was calculated using 'intention to treat' and 'complete case' analyses. RESULTS: The ONS group gained significantly more QALYs than the dietary advice group at significantly greater costs. The ICER (extra cost per QALY gained), adjusted for nutritional status, type of care, baseline costs and quality of life, was found to be £10,961 using the 'intention to treat' analysis (£190.60 (cost)/0.0174 (QALYs); n = 104) and £11,875 using 'complete case' analysis (£217.30/0.0183; n = 76) (2016 prices). Sensitivity analysis based on 'intention to treat' data indicated an 83% probability that the ICER was ≤£20,000 and 92% that it was ≤£30,000. With the 'complete case data' the probabilities were 80% and 90% respectively. CONCLUSION: This pragmatic randomised trial involving one of the oldest populations subjected to a cost-utility analysis, suggests that use of oral nutritional supplements in care homes are cost-effective relative to dietary advice.
0261-5614
Parsons, Emma
4c139c27-03d0-4fba-9261-5e04eb06ab9c
Parsons, Emma
4c139c27-03d0-4fba-9261-5e04eb06ab9c
Cawood, Abbie L.
4067d429-6ce8-4e50-b5f5-d8bf62aada79
Smith, Trevor
53e6838c-2e95-4c8f-9325-53163ab6255d
Stratton, Rebecca J.
c6a5ead1-3387-42e7-8bea-5ac7d969d87b
Parsons, Emma
4c139c27-03d0-4fba-9261-5e04eb06ab9c
Parsons, Emma
4c139c27-03d0-4fba-9261-5e04eb06ab9c
Cawood, Abbie L.
4067d429-6ce8-4e50-b5f5-d8bf62aada79
Smith, Trevor
53e6838c-2e95-4c8f-9325-53163ab6255d
Stratton, Rebecca J.
c6a5ead1-3387-42e7-8bea-5ac7d969d87b

Parsons, Emma, Parsons, Emma, Cawood, Abbie L., Smith, Trevor and Stratton, Rebecca J. (2017) Cost-effectiveness of oral nutritional supplements in older malnourished care home residents. Clinical Nutrition. (doi:10.1016/j.clnu.2017.02.008).

Record type: Article

Abstract

BACKGROUND & AIMS: Malnutrition is common in care home residents, but information on the cost-effectiveness of nutritional interventions is lacking. This study, involving a randomised trial in care home residents, aimed to examine whether oral nutritional supplements (ONS) are cost-effective relative to dietary advice. METHODS: An incremental cost-effectiveness analysis was undertaken prospectively in 104 older care home residents (88 ± 8 years) without overt dementia, who were randomised to receive either ONS or dietary advice for 12 weeks. Costs were estimated from resource use and quality adjusted life years (QALYs) from health-related quality of life, assessed using EuroQoL (EQ-5D-3L, time-trade-off) and mortality. The incremental cost-effectiveness ratio (ICER) was calculated using 'intention to treat' and 'complete case' analyses. RESULTS: The ONS group gained significantly more QALYs than the dietary advice group at significantly greater costs. The ICER (extra cost per QALY gained), adjusted for nutritional status, type of care, baseline costs and quality of life, was found to be £10,961 using the 'intention to treat' analysis (£190.60 (cost)/0.0174 (QALYs); n = 104) and £11,875 using 'complete case' analysis (£217.30/0.0183; n = 76) (2016 prices). Sensitivity analysis based on 'intention to treat' data indicated an 83% probability that the ICER was ≤£20,000 and 92% that it was ≤£30,000. With the 'complete case data' the probabilities were 80% and 90% respectively. CONCLUSION: This pragmatic randomised trial involving one of the oldest populations subjected to a cost-utility analysis, suggests that use of oral nutritional supplements in care homes are cost-effective relative to dietary advice.

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More information

Accepted/In Press date: 7 February 2017
e-pub ahead of print date: 11 February 2017
Organisations: Human Nutrition & Metabolism, Human Development & Health, Medicine

Identifiers

Local EPrints ID: 410368
URI: http://eprints.soton.ac.uk/id/eprint/410368
ISSN: 0261-5614
PURE UUID: 7387723a-bd07-4fbb-a287-ffe4c88580bf

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Date deposited: 07 Jun 2017 16:31
Last modified: 15 Mar 2024 14:06

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Contributors

Author: Emma Parsons
Author: Emma Parsons
Author: Abbie L. Cawood
Author: Trevor Smith
Author: Rebecca J. Stratton

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