title: Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: a randomised controlled pilot study.
abstract: OBJECTIVE
  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
  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: [euro]2.30 and maximum: [euro]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: [euro]9497 and [euro]12,099/additional QALY, respectively) but deemed cost-effective according to international thresholds (< [euro]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.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Charite-University Medicine, Berlin, Germany. kristina.norman@charite.de
authors.forename: K
authors.initials: K
authors.lastname: Norman
authors.forename: M
authors.initials: M
authors.lastname: Pirlich
authors.forename: C
authors.initials: C
authors.lastname: Smoliner
authors.forename: A
authors.initials: A
authors.lastname: Kilbert
authors.forename: J D
authors.initials: JD
authors.lastname: Schulzke
authors.forename: J
authors.initials: J
authors.lastname: Ockenga
authors.forename: H
authors.initials: H
authors.lastname: Lochs
authors.forename: T
authors.initials: T
authors.lastname: Reinhold
mesh_terms: D000328:Adult; D019540:Area Under Curve; D003362:Cost-Benefit Analysis; D004044:Dietary Proteins / Q000008:administration & dosage / Q000191:economics; D019587:Dietary Supplements / Q000191:economics*; D002149:Energy Intake; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications*; D006304:Health Status; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D008875:Middle Aged; D044623:Nutrition Therapy / Q000191:economics*; D010865:Pilot Projects; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins