title: Cost-effectiveness of oral nutritional supplements in older malnourished care home residents.
abstract: Malnutrition is common in care home residents, but information on the cost-effectiveness of nutritional interventions is lacking. This study, involving a randomised trial in care home residents, aimed to examine whether oral nutritional supplements (ONS) are cost-effective relative to dietary advice.
  
  
  
  An incremental cost-effectiveness analysis was undertaken prospectively in 104 older care home residents (88 ± 8 years) without overt dementia, who were randomised to receive either ONS or dietary advice for 12 weeks. Costs were estimated from resource use and quality adjusted life years (QALYs) from health-related quality of life, assessed using EuroQoL (EQ-5D-3L, time-trade-off) and mortality. The incremental cost-effectiveness ratio (ICER) was calculated using 'intention to treat' and 'complete case' analyses.
  
  
  
  The ONS group gained significantly more QALYs than the dietary advice group at significantly greater costs. The ICER (extra cost per QALY gained), adjusted for nutritional status, type of care, baseline costs and quality of life, was found to be £10,961 using the 'intention to treat' analysis (£190.60 (cost)/0.0174 (QALYs); n = 104) and £11,875 using 'complete case' analysis (£217.30/0.0183; n = 76) (2016 prices). Sensitivity analysis based on 'intention to treat' data indicated an 83% probability that the ICER was ≤£20,000 and 92% that it was ≤£30,000. With the 'complete case data' the probabilities were 80% and 90% respectively.
  
  
  
  This pragmatic randomised trial involving one of the oldest populations subjected to a cost-utility analysis, suggests that use of oral nutritional supplements in care homes are cost-effective relative to dietary advice.
authors.affiliation: Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. Electronic address: m.elia@soton.ac.uk.
authors.forename: Marinos
authors.initials: M
authors.lastname: Elia
authors.affiliation: Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Parsons
authors.affiliation: Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
authors.forename: Abbie L
authors.initials: AL
authors.lastname: Cawood
authors.affiliation: Department of Gastroenterology, University Hospitals Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
authors.forename: Trevor R
authors.initials: TR
authors.lastname: Smith
authors.affiliation: Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stratton
mesh_terms: D000284:Administration, Oral; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000191:economics*; D003376:Counseling; D004032:Diet / Q000379:methods; D019587:Dietary Supplements / Q000191:economics*; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000178:diet therapy / Q000188:drug therapy* / Q000191:economics*; D009752:Nutritional Status; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
keywords: Care home; Cost-effectiveness; Dietary advice; ICER; Oral nutritional supplements; QALY