Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence

Abstract

Malnutrition is a costly problem for health care systems internationally. Malnourished individuals require longer hospital stays and more intensive nursing care than adequately nourished individuals and have been estimated to cost an additional £7.3 billion in health care expenditures in the United Kingdom alone. However, treatments for malnutrition have rarely been considered from an economic perspective. The aim of this systematic review was to identify the cost effectiveness of using protein and energy supplementation, as a widely used intervention to treat adults with and at risk of malnutrition. Papers were identified that included economic evaluations of protein or energy supplementation for the treatment or prevention of malnutrition in adults. While the variety of outcome measures reported for cost effectiveness studies made synthesis of results challenging, cost benefit studies indicated that the savings for the health system could be substantial due to reduced lengths of hospital stay and less intensive use of health services after discharge. In summary the available economic evidence indicates that protein and energy supplementation in treatment or prevention of malnutrition provides an opportunity to improve patient wellbeing and lower health system costs.

Cost‐Effectiveness of Nutrition Intervention in Long‐Term Care

“…An important limitation of this study is that it was not designed to detect the cost‐effectiveness of nutrition intervention on total LTC costs or other outcomes associated with poor caloric intake, such as pressure ulcers, hospitalizations, and mortality . In addition, overall attrition was high (35%) but comparable between groups and similar to that found in prior prospective LTC studies …”

“…2,[16][17][18] It is unclear which nutrition intervention is more costeffective in increasing caloric intake and weight in LTC residents. 19 The cost-effectiveness component is critical to further evaluation studies because supplements represent a significant financial cost to LTC facilities because many residents have an ONS order, yet LTC staffing resources may limit quality care provision to all residents in need. [13][14][15][20][21][22] It is also unclear to what extent weight loss can be prevented in a LTC population with multiple comorbidities.…”

Handgrip strength measurement as a predictor of hospitalization costs

“…Despite the higher costs that undernutrition implies, identification of undernourished patients and proper nutritional treatment can reduce hospitalization costs. [17][18][19] A study from 2005 showed that the incremental cost of 1 less day in hospital for undernourished patients due to nutritional treatment was €76, whereas the mean cost of 1 day in hospital was €476 for university hospitals and €337 for peripheral hospitals. 17 This study stated that the incremental costs of undernutrition screening and treatment to reduce the length of hospital stay by 1 day were higher in undernourished patients who had HGS higher than the standard compared with those of undernourished patients with HGS lower than the standard.…”

“…16 This information on the economic impact of undernutrition emphasizes the importance of identifying and treating undernourishment, as it has been shown that screening and nutritional treatment of undernourished patients can lower hospitalization costs. [17][18][19] There is an increasing evidence that handgrip strength (HGS) is a reliable and attractive method used in clinical daily practice to identify undernutrition. [20][21][22] Undernutrition is associated with impaired hand muscle function and HGS reflects early nutrition deprivation and repletion, before changes in body composition parameters can be detected.…”

Is the skeleton still in the hospital closet? A review of hospital malnutrition emphasizing health economic aspects

“…In nearly all circumstances, lowered health system expenses were associated with such supplements [36,39].…”