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

Yue Zhong (), Joshua T. Cohen, Scott Goates, Menghua Luo, Jeffrey Nelson and Peter J. Neumann
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Yue Zhong: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
Joshua T. Cohen: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
Scott Goates: Abbott Nutrition
Menghua Luo: Abbott Nutrition
Jeffrey Nelson: Abbott Nutrition
Peter J. Neumann: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center

Applied Health Economics and Health Policy, 2017, vol. 15, issue 1, No 9, 75-83

Abstract: 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 β-hydroxy-β-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.

Date: 2017
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DOI: 10.1007/s40258-016-0269-7

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