title: The Cost-Effectiveness of Oral Nutrition Supplementation for Malnourished Older Hospital Patients.
abstract: BACKGROUND
  Malnutrition, which is associated with increased medical complications in older hospitalized patients, can be attenuated by providing nutritional supplements.
  
  
  OBJECTIVE
  This study evaluates the cost effectiveness of a specialized oral nutritional supplement (ONS) in malnourished older hospitalized patients.
  
  
  METHODS
  We conducted an economic evaluation alongside a multicenter, randomized, controlled clinical trial (NOURISH Study). The target population was malnourished older hospitalized patients in the USA. We used 90-day (base case) and lifetime (sensitivity analysis) time horizons. The study compared a nutrient-dense ONS, containing high protein and β-hydroxy-β-methylbutyrate to placebo. Outcomes included health-care costs, measured as the product of resource use and per unit cost; quality-adjusted life-years (QALYs) (90-day time horizon); life-years (LYs) saved (lifetime time horizon); and the incremental cost-effectiveness ratio (ICER). All costs were inflated to 2015 US dollars.
  
  
  RESULTS
  In the base-case analysis, 90-day treatment group costs averaged US$22,506 per person, compared to US$22,133 for the control group. Treatment group patients gained 0.011 more QALYs than control group subjects, reflecting the treatment group's significantly greater probability of survival through 90 days' follow-up, as reported by the clinical trial. Hence, the 90-day follow-up period ICER was US$33,818/QALY. Assuming a lifetime time horizon, estimated treatment group life expectancy exceeded control group life expectancy by 0.71 years. Hence, the lifetime ICER was US$524/LY. The follow-up period for the trial was relatively short. Some of the patients were lost to follow-up, thus reducing collection of health-care utilization data during the clinical trial.
  
  
  CONCLUSIONS
  Our findings suggest that the investigative ONS cost-effectively extends the lives of malnourished hospitalized patients.
authors: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box #63, Boston, MA, 02111, USA. yzhong@tuftsmedicalcenter.org.
authors: Yue
authors: Y
authors: Zhong
authors: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box #63, Boston, MA, 02111, USA.
authors: Joshua T
authors: JT
authors: Cohen
authors: Abbott Nutrition, Columbus, OH, USA.
authors: Scott
authors: S
authors: Goates
authors: Abbott Nutrition, Columbus, OH, USA.
authors: Menghua
authors: M
authors: Luo
authors: Abbott Nutrition, Columbus, OH, USA.
authors: Jeffrey
authors: J
authors: Nelson
authors: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box #63, Boston, MA, 02111, USA.
authors: Peter J
authors: PJ
authors: Neumann
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D044342:Malnutrition / Q000191:economics* / Q000628:therapy; D044623:Nutrition Therapy / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years