The Economic Value of Enteral Medical Nutrition in the Management of Disease-Related Malnutrition: A Systematic Review

doi:10.1016/j.jamda.2013.09.005

Journal of the American Medical Directors Association

Volume 15, Issue 1, January 2014, Pages 17-29

https://doi.org/10.1016/j.jamda.2013.09.005 Get rights and content

Abstract

Economic evaluations for medical nutrition, such as oral nutritional supplements (ONS), are relatively uncommon compared with other health technologies, and represent an area that has not been reviewed so far. In this systematic review, economic evaluations of enteral medical nutrition in the management of disease-related malnutrition (DRM) were reviewed and qualified to estimate the economic value. Initially, 481 studies were found, of which 37 full-text articles were assessed for eligibility and were rated on their quality using the Quality of Health Economic Studies (QHES) instrument. The final review focused on the high QHES quality economic evaluation studies. As both the studied medical nutrition intervention and the form of the economic evaluation varied, a quantitative synthesis (meta-analysis) was not attempted but a critical analysis and comparison of the individual study results were performed. ONS was the most studied intervention, covering several patient populations and different health care settings. Outcomes included cost savings (n = 3), no significant extra costs per unit of clinical and/or functional improvement (n = 1), or significantly higher costs per unit of clinical and/or functional improvement but still cost-effective for the used threshold (n = 4). This review shows that the use of enteral medical nutrition in the management of DRM can be efficient from a health economic perspective.

Section snippets

Methods

This systematic review was conducted according to the UK National Health Service Centre for Reviews and Dissemination (CRD) guidelines²² and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.²³ The principal stages and steps undertaken in the reviewing process are shown in Figure 1.

Overall Literature Search Findings (n = 37 Economic Evaluation Studies)

The search strategy resulted in 522 studies eligible for inclusion, of which 481 records remained after removing duplicates (Figure 1). After having evaluated the titles and the abstracts (when available) according to the inclusion and exclusion criteria, a total of 37 full-text articles were assessed for eligibility.10, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64 Studies of which the abstract was

Discussion

To our knowledge, this is the first systematic review of research on the efficiency of enteral medical nutrition for DRM in adults in developed countries. The results show that managing several patient populations suffering from or at risk of DRM in different health care settings with enteral medical nutrition is an efficient intervention. ONS was the most frequently studied form. The duration of using enteral medical nutrition varied from 3 years in patients with CVA with ETF to 17 days of ONS

Conclusion

This systematic review was the first to estimate the costs in relation to the outcomes (efficiency) of enteral medical nutrition for DRM in adults in developed countries. Full economic evaluations that met the inclusion criteria were rated on their quality first, before judging the results, as high-quality studies have generally higher validity. Managing several patient populations suffering from or at risk of DRM in different health care settings with enteral medical nutrition, seems to be an

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: KF is a PhD student at Maastricht University, and is also an employee of Nutricia Advanced Medical Nutrition (NAMN). The University of Maastricht has an unrestricted agreement with NAMN to enable KF to do research.

: All authors were involved in the research methods and procedures. KF, MJLB, and MJP conducted the review; KF wrote the paper and had primary responsibility for the final content; MJLB, MJCN, MJP, JMGA, JMMM, and RJGH reviewed the paper. All authors have read and approved the final manuscript.

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ReviewThe Economic Value of Enteral Medical Nutrition in the Management of Disease-Related Malnutrition: A Systematic Review

Abstract

Section snippets

Methods

Overall Literature Search Findings (n = 37 Economic Evaluation Studies)

Discussion

Conclusion

Clin Nutr

Ageing Res Rev

Ageing Res Rev

Clin Nutr

Clin Nutr

J Am Med Assoc

Gastroenterology

Clin Nutr

Clin Nutr

Nutrition

Am J Clin Nutr

J Ren Nutr

Clin Nutr

HPB

Clin Nutr

Clin Nutr Suppl

Nutrition

J Am Med Dir Assoc

Lancet

J Ren Nutr

Value Health

Economic evaluation and health care. What does it mean?

BMJ

Methods for the economic evaluation of health care programmes

A clinician's guide to cost-effectiveness analysis

Ann Intern Med

‘Health economics’ and the evolution of economic evaluation of health technologies

Health Econ

ESPEN Guidelines on adult enteral nutrition

Clin Nutr

Disease-related malnutrition and enteral nutrition therapy: A significant problem with a cost-effective solution

Nutr Clin Pract

Disease-related Malnutrition: An Evidence-based Approach to Treatment

The Cost of Disease-Related Malnutrition in the UK and Economic Considerations for the use of Oral Nutritional Supplements (ONS) in Adults

Who benefits from nutritional support: What is the evidence?

Eur J Gastroenterol Hepatol

Review
The Economic Value of Enteral Medical Nutrition in the Management of Disease-Related Malnutrition: A Systematic Review