Food and Behaviour Research

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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

Elia M, Normand C, Laviano A, Norman K. (2015) Clin Nutr. Jul 30.  doi: 10.1016/j.clnu.2015.07.012. [Epub ahead of print] 

Web URL: View this and related abstracts via PubMed here. Free full text of this article is available online

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  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.

FAB RESEARCH COMMENT:

For an accessible summary of this research, see the associated news article:
See also the similar review of cost-benefit studies involving oral nutritional supplements used in hospital settings: