OBJECTIVES: This systematic literature review summarizes key findings from health economic evaluations in older adults with or at risk of malnutrition receiving oral nutrition supplement (ONS) interventions.
METHODS: This review utilized six electronic databases (PubMed, Embase, EconLit, CINAHL, Cochrane, Scopus) to identify health economic evaluations comparing ONS versus any comparators among older adults published between January 2014-February 2024. Inclusion criteria were publication in English, full text, and population with mean age ≥60 years. The Consolidated Health Economic Evaluation Reporting Standards checklist informed data extraction and reporting quality. Methodological quality of studies was assessed using the Drummond 10-item checklist. This study was registered with PROSPERO (CRD42023459161).
RESULTS: Of the 1,459 records identified and screened, 11 studies met the inclusion criteria (4 cost-effectiveness analyses [CEA], 2 cost-utility analyses [CUA], 2 budget-impact analyses [BIA], 1 cost-minimization analysis, 1 CEA plus CUA, 1 BIA plus CEA). Studies were conducted in hospital settings (n=5) in different countries (n=7), had time horizons ≤6 months (n=9), were trial-based (n=8), had usual care as comparators (n=9), and included both healthcare and intervention costs (n=10). Across all studies, ONS intervention costs were low, resulting in lower or slightly higher total healthcare costs (e.g., ONS cost of €189 and total healthcare costs €191 lower at 18 weeks vs. comparator). In 10 studies, ONS interventions had higher overall patient health outcomes vs. comparators (e.g., significantly faster pressure ulcer healing at 8 weeks). In 6 studies that reported quality-adjusted life-years (QALYs), ONS interventions resulted in slightly higher QALYs vs. comparators (e.g., 3-month incremental QALY gain of 0.011). All studies concluded ONS intervention was cost-effective or cost saving.
CONCLUSIONS: ONS improves patient outcomes among at-risk or malnourished older adults in hospital and community settings at minimal costs to healthcare systems. Future studies with longer time horizons are needed to characterize longer-term benefits and costs of ONS interventions
