Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: a randomised controlled pilot study

Background/Objectives: 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. Subjects/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: (sic)2.30 and maximum: (sic)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: (sic)9497 and (sic)12 099/additional QALY, respectively) but deemed cost-effective according to international thresholds (<(sic)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. European Journal of Clinical Nutrition (2011) 65, 735-742; doi:10.1038/ejcn.2011.31; published online 16 March 2011