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Table 40Oral nutrition – economic analyses: results

StudyComparisonEffectiveness (per patient)Cost (per patient)Incremental cost-effectiveness
Aihara et al 20036, Japan61) Feeding commences day 1 post-op

2) Feeding commences day 4 post-op
Complications6
1) 29.4%
2) 18.2% [p=0.409]
Cost (median?)
1) $2028
2 ) $3177 [p<0.001]
LOS (median)
1) 11 days
2) 18 days [p<0.001]
Since costs were expressed as median, ICER was not calculated
Arnaud-Battandier et al 2004, France91) Frequent prescription of oral nutrition supplements
2) Rare prescription of oral nutrition supplements
Adjusted MNA score at 12 months
1) 18.5
2) 17.2 [p<0.01]
Mortality
1) 14% 2) 17%
1) 2499 euro
2) 2694 euro
1) vs 2) −195 (−929, 478)
1) dominates 2)
BAPEN 2005 (draft report), UK911) Oral nutritional supplements
2) Standard care
NASurgery patients & mixed patients
1) v 2)
A) −£959 (IQR: −£1116, −£787)
B) −£298 (IQR: −£363, −£217)
Supplements both reduced complications and reduced cost
Edington et al 2004, UK871) Oral supplements
2) Standard care
No significant difference in quality of life (quality of life scores and p value were not reported)Cost of hospital admissions:
1) £3034
2) £1855, [p=0.034]
Intervention 2 was cost-saving (£1179)
Lawson et al 2003, UK1981) Oral supplements
2) No intervention
1) 16.6%
2) 35.1%, [p= 0.005]
1) £30.16
2) £46.23
Intervention 1 dominated
Pang et al 2004 (unpublished submission from Abbott Laboratories), UK2651) Preop Assessment, dietary advice and oral intervention mixture of fortification and/or supplements
2) No preop intervention
Not reported1) vs 2) Between £17.25 and £42.18 depending on assumptions about % of patients on ONS, % receiving assessmentIf 3 or more bed-days are averted per complication then preop oral nutritional assessment and intervention will be cost-saving
Smedley et al 2003, UK (unpublished)3251) Pre- and post-operative oral supplements
2) Post-operative oral supplements
3) Pre-operative oral supplements
4) No nutritional supplements
1) 0.31
2) 0.37
3) 0.41
4) 0.68 [p values were not reported]
1) £2289
2) £2324
3) £2286
4) £2618
Interventions 1, 2 and 3 (providing oral nutrition supplements) dominated intervention 4
Stratton 2003, UK3351) Oral supplements
2) Standard care
N/A1) £48
2) £500
Intervention 1 was cost-saving (£452)
1) Oral supplements
2) Standard care
N/A1) £120
2) £4544
Intervention 1 was cost-saving (£4424)
1) Oral supplements
2) Standard care
N/A1) £222
2) £4064
Intervention 1 was cost-saving (£3842)
1) Oral supplements
2) Standard care
N/A1) £63
2) £6500
Intervention 1 was cost-saving (£6437)
1) Oral supplements (protein, mineral and vitamins)
2) Oral supplements (minerals and vitamin)
N/A1) £144
2) £8323
Intervention 1 was cost-saving (£8179)
1) Oral supplements
2) Standard care
N/A1) £33
2) £865
Intervention 1 was cost-saving (£832)
1) Oral supplements
2) Standard care
N/A1) £21
2) £622
Intervention 1 was cost-saving (£601)
1) Oral supplements
2) Standard care
N/A1) £219
2) £571
Intervention 1 was cost-saving (£352)
1) Oral supplements
2) Standard care
N/A1) £36
2) £756
Intervention 1 was cost-saving (£720)
6

There were no cases of pneumonia or anastomic leakage.

There were no cases of pneumonia or anastomic leakage.

From: Appendix Four, Evidence Tables

Cover of Nutrition Support for Adults
Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition.
NICE Clinical Guidelines, No. 32.
National Collaborating Centre for Acute Care (UK).
Copyright © 2006, National Collaborating Centre for Acute Care.

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