Multidisciplinary Nutritional Support for Undernutrition in Older Adults in Nursing Home and Home-Care is Cost- Effective

Abstract

Few intervention studies have evaluated the cost-effectiveness of nutritional support among frail older adults and none of these have been multidisciplinary. The aim of the study was to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care identified with the validated Eating Validation Scheme (EVS). The design was an 11 week cluster randomized trial with setting (home-care or nursing home) as the unit of randomization. Before the start of the study a train-the-trainer intervention was performed involving educated nutrition coordinators. In addition, the participants assigned to the intervention group strategy received multidisciplinary nutrition support. Focus was on treatment of the potentially modifiable nutritional risk factors identified with EVS, by involving physiotherapist, registered dietician, and occupational therapist, as relevant and independent of the municipality’s ordinary assessment and referral system. Outcome parameters used for the cost-effectiveness analysis were costs and time of the intervention, quality of life (by means of Euroquol-5D-3L); and change in weight. Respectively, 55 (46 from home-care) and 40 (18 from home-care) were identified by EVS and comprised the intervention and control group. A difference was seen after 11 weeks in quality of life (0.758 (± 0.222) vs. 0.534 (± 0.355), p = 0.001). Even though a small gain in weight was observed in the intervention group there was no difference in change in weight. The effect on quality of life, measured in terms of Quality-Adjusted Life Year (QALY) gain relatively to the control group, gave a cost-effectiveness ratio of DKK 46,000 per QALY gained which compares reasonably well to other interventions found worthwhile in the Danish healthcare sector.