COST-EFFECTIVENESS OF A 3-MONTH INTERVENTION WITH ORAL NUTRITIONAL SUPPLEMENTS IN DISEASE RELATED MALNUTRITION: A RANDOMIZED CONTROLLED PILOT STUDY
Résumé
Background: 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. Methods: 114 malnourished patients (50.6±16.1 years, 63 female) with benign gastrointestinal disease were included and randomised to receive either ONS for three 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 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 2 different pricing scenarios for ONS (minimum price: 2.30€ and maximum: 2.93€/tetra pack). 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 three months the health-status utilities were significantly higher in intervention patients than control patients (0.731±0.015 vs. 0.671±0.016, p=0.028). Intervention was associated with significantly higher costs (ICER: €9,497 and €12,099 /additional QALY, respectively) but deemed cost-effective according to international thresholds (<€50,000/QALY). Conclusions: Three 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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