The impact of malnutrition on healthcare costs and economic considerations for the use of oral nutritional supplements

Abstract

Summary Background A systematic analysis of the costs of disease-related malnutrition in the UK and use of oral nutritional supplements in hospital and community settings was undertaken to inform the National Institute for Health and Clinical Excellence. Methods Costs of disease-related malnutrition were calculated for 2003 based on reported prevalence of malnutrition in different care settings, prevalence of home artificial nutrition support, hospital length of stay, national reference costs for healthcare services and costs of nutritional products. Studies investigating the use of oral nutritional supplements which reported end points amenable to economic evaluation were identified. Variables included amount of product consumed, length of hospital stay and complications. Results The annual expenditure on managing patients with medium or high risk of disease-related malnutrition was estimated to be ∼£7.3 billion (∼€10.5 billion). Over half was spent on hospital care and a similar proportion on individuals over 65 years of age. In abdominal surgery, use of supplements produced a mean cost saving of ∼£700 (∼€1000) per patient. There was also a net cost saving through supplementation in orthopaedic surgery, elderly care and prior to elective surgery. Conclusions The British Association for Parenteral and Enteral Nutrition (BAPEN) report provides some insights into the economic burden of malnutrition and the value of oral nutritional supplements in one healthcare system. Further clinical trials with endpoints that lend themselves to economic modelling undertaken particularly in the community would be helpful to expand the understanding of the economic benefits of appropriate use of oral nutritional supplements. In the meantime, the approach taken by BAPEN in the UK could serve as a useful blueprint for economic evaluation of malnutrition burden and provision of oral nutritional supplements in other countries.