title: Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs.
abstract: OBJECTIVE
  Older people are vulnerable to malnutrition which leads to increased health care costs. The aim of this study was to evaluate the cost-effectiveness of nutritional supplementation from a societal perspective.
  
  
  METHODS
  This randomized controlled trial included hospital admitted malnourished elderly (≥ 60 y) patients. Patients in the intervention group received nutritional supplementation (energy and protein enriched diet, oral nutritional support, calcium-vitamin D supplement, telephone counselling by a dietician) until three months after discharge from hospital. Patients in the control group received usual care (control). Primary outcomes were Quality Adjusted Life Years (QALYs), physical activities and functional limitations. Measurements were performed at hospital admission and three months after discharge. Data were analyzed according to the intention-to-treat principle and multiple imputation was used to impute missing data. Incremental cost-effectiveness ratios were calculated and bootstrapping was applied to evaluate cost-effectiveness. Cost-effectiveness was expressed by cost-effectiveness planes and cost-effectiveness acceptability curves.
  
  
  RESULTS
  210 patients were included, 105 in each group. After three months, no statistically significant differences in quality of life and physical activities were observed between groups. Functional limitations decreased significantly more in the intervention group (mean difference -0.72, 95% CI-1.15; -0.28). There were no differences in costs between groups. Cost-effectiveness for QALYs and physical activities could not be demonstrated. For functional limitations we found a 0.95 probability that the intervention is cost-effective in comparison with usual care for ceiling ratios > €6500.
  
  
  CONCLUSIONS
  A multi-component nutritional intervention to malnourished elderly patients for three months after hospital discharge leads to significant improvement in functional limitations and is neutral in costs. A follow-up of three months is probably too short to detect changes in QALYs or physical activities.
authors.affiliation: Departments of Nutrition and Dietetics, Internal Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. f.neelemaat@vumc.nl
authors.forename: Floor
authors.initials: F
authors.lastname: Neelemaat
authors.forename: Judith E
authors.initials: JE
authors.lastname: Bosmans
authors.forename: Abel
authors.initials: A
authors.lastname: Thijs
authors.forename: Jaap C
authors.initials: JC
authors.lastname: Seidell
authors.forename: Marian A E
authors.initials: MA
authors.lastname: van Bokhorst-de van der Schueren
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002136:Calcium, Dietary / Q000008:administration & dosage; D002762:Cholecalciferol / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D044342:Malnutrition / Q000178:diet therapy*; D008875:Middle Aged; D018529:Nutritional Support / Q000191:economics* / Q000379:methods*; D010349:Patient Compliance; D010351:Patient Discharge; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D002136:Calcium, Dietary; D004044:Dietary Proteins; D002762:Cholecalciferol