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Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: a randomised controlled pilot study

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Abstract

Background/Objectives:

Nutritional intervention with oral nutritional supplements (ONS) has been shown to increase quality of life in malnourished patients. We investigated whether post-hospital supplementation with ONS is cost-effective according to international benchmarks in malnourished patients.

Subjects/Methods:

In total, 114 malnourished patients (50.6±16.1 years, 57 female) with benign gastrointestinal disease were included and randomised to receive either ONS for 3 months and dietary counselling at discharge (intervention, n=60) or only dietary counselling at discharge (control group, n=54). Nutritional status was assessed with Subjective Global Assessment. Intervention patients documented daily intake of ONS; quality of life was assessed with Short-Form (SF)-36 Health Survey and SF-36 values were transformed into health-status utilities. Quality-adjusted life years (QALYs) were calculated by adopting the area under the curve method. We used two different pricing scenarios for ONS (minimum price: €2.30 and maximum: €2.93/tetrapack). The incremental cost-effectiveness ratio (ICER) of supplementation with ONS was calculated for both price scenarios. All analyses were corrected for age and gender.

Results:

Intervention patients consumed 2.4±0.8 ONS per day. Intervention and control patients did not differ in their health status utilities at baseline (0.594±0.017 vs 0.619±0.018), but after 3 months, the health status utilities were significantly higher in intervention patients than in control patients (0.731±0.015 vs 0.671±0.016, P=0.028). Intervention was associated with significantly higher costs (ICER: €9497 and €12 099/additional QALY, respectively) but deemed cost-effective according to international thresholds (<€50 000/QALY).

Conclusions:

A 3-month intervention with ONS increases quality of life in malnourished patients. This treatment appears to be cost-effective according to international benchmarks.

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Acknowledgements

This study was financially supported by a grant from Fresenius Kabi, Bad Homburg, Germany.

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Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Endocrinology, Charite-University Medicine, Berlin, Germany

    K Norman, M Pirlich, C Smoliner, A Kilbert & H Lochs

  2. Department of General Medicine, Charite-University Medicine, Berlin, Germany

    J D Schulzke

  3. Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany

    J Ockenga

  4. Institute for Social Medicine, Epidemiology and Health Economics, Charite-University Medicine, Berlin, Germany

    T Reinhold

Authors
  1. K Norman
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  2. M Pirlich
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  3. C Smoliner
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  4. A Kilbert
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  5. J D Schulzke
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  6. J Ockenga
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  7. H Lochs
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  8. T Reinhold
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Correspondence to K Norman.

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The authors declare no conflict of interest.

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Registered at Clinical Trials.gov: NCT00168935

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Norman, K., Pirlich, M., Smoliner, C. et al. Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: a randomised controlled pilot study. Eur J Clin Nutr 65, 735–742 (2011). https://doi.org/10.1038/ejcn.2011.31

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  • DOI: https://doi.org/10.1038/ejcn.2011.31

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