Health economic value of postacute oral nutritional supplementation in older adult medical patients at risk for malnutrition: a US-based modelling approach

Abstract

Objective To estimate the health economic value of postdischarge oral nutrition supplement (ONS) consumption among elderly adults who were malnourished during hospitalisation.Design A cost-effectiveness model was developed from a US payer perspective based on a recent meta-analysis of randomised trials of nutritional support following hospital discharge and studies of US hospital mortality, readmission rates and costs.Participants and setting The target population of this study was postacute care US patients aged ≥65 years who were identified as malnourished during hospitalisation.Intervention and outcome measures A decision-tree model was used to evaluate the impact of postacute care daily consumption of ONS compared with no ONS. Outcomes were evaluated over a 1-year time interval. Clinical outcomes of interest included readmission and mortality rates. Economic value of ONS was quantified using three different metrics: cost per death averted, cost per readmission avoided and direct cost savings resulting from changes in postacute mortality and readmission rates. The economic value of ONS was also measured by gains in quality-adjusted life-years.Results Compared with patients not receiving ONS after hospital discharge, use of ONS during the postacute phase reduced mortality by 36.3% and readmissions by 11.0%. Reductions in readmissions resulted in annual savings of US$1113 per person. When extrapolating the results to the estimated 1 693 034 hospitalised elderly US adults at risk of malnutrition, the use of ONS after hospital discharge would prevent 67 747 deaths and 116 570 hospital readmissions per year. With the estimated cost of nutritional support at US$175 per patient per month corresponding to two servings ONS per day, the ONS cost per death and readmission avoided was estimated at US$4380 and US$2546, respectively.Conclusions Postdischarge use of ONS among patients at risk for malnutrition is highly cost-effective with important reductions in mortality and readmission rates.