Introduction Malnutrition has a detrimental effect on quality of life (QOL) but the extent to which nutrition support can improve QOL in a cost effective manner is unclear. This study aimed to examine whether oral nutritional supplements are cost effective in improving quality adjusted life years (QALY's) (an index of quality and quantity of life) in malnourished care home residents.
Methods A randomised controlled trial (RCT) of 104 malnourished residents (medium + high risk according to Malnutrition Universal Screening Tool (“MUST”)) (mean age 88.3±7.7 y, 86% female) in residential and nursing homes in Hampshire received either oral nutritional supplements (ONS) with guidance on how to use them (Nutricia range; mean intake 333±237 kcal/d; n=53) or written and verbal dietary advice (DA) for 12 weeks. QALY's were calculated using quality of life, measured with EuroQol Time Trade Off (EQ-5D TTO) and information on mortality. Expenditure on healthcare use (healthcare professional visits and hospital admissions (for the 3 months prior to and during the RCT)) and the interventions were calculated using unit costs.1 2 The expenditure and QALY's were used to establish the Incremental Cost Effectiveness Ratio (ICER).
Results QALY TTO was significantly higher in the ONS group than the DA group (0.14±0.04 vs 0.12±0.03, p=0.023, total n=70). Total expenditure was greater in the ONS group than the DA group (ONS: £375.70±213.78, DA: £173.85±240.15, p<0.0001) due to the cost of the intervention (ONS: £173.71±126.06, DA: £39.75±32.25, p<0.0001). Healthcare use costs were not significantly different between groups (ONS: £153.62±208.44, DA: £127.27±250.03, p=0.639). The mean ICER (cost/QALY TTO) was £10 698 (95% CI £3793 to £76 932), which is well below the typically considered threshold of £25 000/QALY indicative of cost effectiveness.
Conclusion This RCT indicates that compared to simple dietary advice, oral nutritional supplements are cost effective in improving the quality adjusted life years of malnourished care home residents.
Competing interests None declared.
References 1. Curtis L. Unit Costs of Health and Social Care. University of Kent, 2009.
2. British National Formulary. 42 edn. 2006.