They said the clinical benefits of using standard oral nutritional supplements in community and care homes were well documented – but the economic viability of translating this into public health policy remained unclear.
Of the 19 international papers included – which included dietary interventions in all non-hospital settings with individuals of all ages over one year – most showed supplement use was cost-effective.
“This review of studies, mainly of randomised controlled clinical trials, suggests that the use of standard ONS [oral nutritional supplements] in the community, with or without additional use in hospital, produces an overall net cost saving favouring the ONS group, or a near neutral balance,” wrote the researchers from the University of Southampton in the UK, Trinity College in Ireland, Sapienza University in Italy and Charité Medical University in Germany.
The researchers said the burden of malnutrition could be felt on both an individual and societal level – with loss of independence and delayed recovery for the individual and increased pressure on public services for the state.
According to a report from the charity BAPEN – penned by one of the same authors – UK public spending on disease-related malnutrition in 2007 amounted to an estimated £13 billion (€18.65bn), 80% of which was in England.
Who's paying?
One UK care home paper included in this latest review suggested supplement use could save £187.91 (€269.53) per resident over three months – equating to £751.64 (€1077.92) saved annually on the cost of screening, management and monitoring.
Meanwhile another paper comparing supplementation with non-supplementation for pre-operative people in the community, a net cost saving of £332 (€476) per patient was made in the supplement group.
Published in the journal Clinical Nutrition, the international review found evidence supplements improved quality of life, reduced infections, reduced minor post-operative complications and reduced falls. It also reduced hospitalisation significantly by about 16.5%.
According to BAPEN, although malnutrition was most commonly associated with older people, the majority of people at risk in the UK were under 65 years. At any given time, over three million people in the UK are either malnourished or at risk of malnutrition.
The vast majority of these (93%) are living in the community, with about 5% in care homes and just 2% in hospital.
However, the researchers said for use in the community practical challenges such as prescription and reimbursement should be considered. They said it could be that prescription costs would be absorbed by thc community while hospitals profited from a reduced workload.
Source: Clinical Nutrition
Published online ahead of print, doi:10.1016/j.clnu.2015.07.012
“A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings”
Authors:M. Elia, C. Normand, A. Laviano, K. Norman