Enteral nutrition and oral nutrition supplements: a review of the economics literature.
BACKGROUND
We sought to review the economics literature on enteral nutrition (EN) and oral nutrition supplements (ONS) against the background of an ongoing clinical guideline development.


METHODS
We searched the Health Economic Evaluations Database, the NHS Economic Evaluation Database, and the Cochrane Database of Systematic Reviews.


RESULTS
Enteral vs parenteral nutrition was found to be the most common comparison undertaken. The randomized trial evidence suggests that, in some groups of patients, EN is better in terms of clinical endpoints and/or length of hospital stay. This should translate into a lower mean cost for EN, given the reduced daily cost. These studies should be treated with caution because of their small sample size and poor quality. Costing was often crude and poorly reported, tending to focus on the narrow costs of the nutrition supplements. Only 1 study of a nutrition supplement in the community setting was found.


CONCLUSIONS
There is some evidence to indicate economic advantages of enteral over parenteral nutrition and of immune-enhancing supplements relative to control diet. There is a lack of well-designed studies taking a broad view of relevant comparators, costs, and outcomes. The cost-effectiveness of different forms of nutrition in different patient groups remains to be established.
Pritchard
Clive
C
Office of Health Economics, London, England. cpritchard@ohe.org
Duffy
Steven
S
Edington
Jackie
J
Pang
Francis
F
D003362:Cost-Benefit Analysis; D019587:Dietary Supplements / Q000191:economics*; D004750:Enteral Nutrition / Q000191:economics*; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D010288:Parenteral Nutrition / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D014481:United States