The randomised trial assessed the use of a solid oral nutritional supplement (ONS) specially adapted to elderly people with poor dental status, finding that not only does use of the supplement result in better health outcomes but also makes economic sense by reducing healthcare costs
Writing in European Geriatric Medicine, the team behind the study said a 2015 randomised controlled trial (RCT) demonstrated that a solid (ONS) in the form of a special formulated cookie (Protibis cookies, France) resulted in an increase of weight and appetite plus decreases in bedsores, diarrhoea and a trend of a decrease of falls and infections.
However, they said that the economic impact of the supplementation program was unknown until the new analysis.
“The present analysis showed that, in a population of malnourished elderly living in institution, the prescription of a new solid ONS lowered both medical events and working time of the nursing staff, and therefore the induced costs,” said the researchers – led by Dr Valérie Pouyssegur at the University of Nice in France.
“The additional cost generated by this new solid ONS in the usual care was compensated with savings generated thanks to the improvement of the nutritional status of the residents,” they confirmed.
Pouyssegur and colleagues analysed data from the same population as in the 2015 trial, which involved 175 malnourished older adults living in seven institutions.
“The economic study was proposed after the end of the pivotal study, which showed relevant results,” said the team. “Therefore, a cost minimization study was proposed.”
The team used an adapted methodology to analyse the economic impact by adopting the health-care payer's perspective – and took into account all direct medical costs.
Direct costs included the price of cookies, ONS and the care of four adverse effects: bedsores, diarrhoea, falls and infections.
“The point of view of the institution (Assisted Living Accommodation) was also considered by assessing the time spent by nurses and nursing auxiliary,” said the team.
During the 18-week period of observation, the consumption of cookies during the first six weeks resulted in a cost minimisation, said the team.
For 18 weeks, the cost cutting was confirmed, mainly in the treatment of falls, with savings due to the reduction of hospital stays and medical consultations, and in the treatment of infections, with savings due to the reduction of hospital stays.
“Savings ranged from 1.52 to 2.48 € daily and per malnourished resident,” said the authors. “For the institution, it also reduced the working time of the nursing staff by 30 min daily and per malnourished resident.”
“Taking into account the cost of cookies, their consumption during 6 weeks over a period of observation of 18 weeks generated a cost minimization for Health Insurance. For nursing home management, the consumption of cookies reduced the working time of the nursing staff by 30 min daily and per malnourished resident. This savings on working time could then be attributed to other tasks,” concluded Pouyssegur and her collagues.
Source: European Geriatric Medicine
Volume 8, Issue 3, Pages 234-239, doi: 10.1016/j.eurger.2017.04.012
“Solid oral supplementation: Economic assessment. Economic impact of the introduction of a solid oral nutritional supplement adapted to malnourished older adults with poor dental health”
Authors: V. Pouysségur, et al