The health economics and outcomes study, conducted by leading health economists, was presented this past weekend at the European Society for Clinical Nutrition and Metabolism (ESPEN) annual congress in Leipzig, Germany, a leading conference in clinical nutrition attracting attendees from more than 80 countries. The study was chosen as one of three “Best Abstracts” slated to be presented at the conference.
The study analyzed more than 1 million adult inpatient cases in the US over an 11-year period ending in 2010. Among the key associations of oral nuturitional supplementation were:
- A 21%, or 2.3 day, reduction in length of stay
- A 21.6%, or $4,734, reduction in patient hospitalization cost (based on inflation-adjusted 2010 dollars).
In addition, supplement use was associated with a 6.8% reduction in the probability of a 30-day readmission in patients who had at least one known subsequent readmission and were provided oral nutritional supplements during the previous hospitalization.
The study, which also was recently published in the American Journal of Managed Care, provides insights into the economic benefits of prescribing oral nutritional supplements to adult patients in the hospital setting.
"Patients identified as having nutritional deficiencies often face a longer and more difficult recovery process, resulting in higher health care costs and an increase in complication rates," said Marinos Elia, MD, BSc Hon, FRCP, Professor of Clinical Nutrition and Metabolism at University of Southampton. "Research demonstrates that oral nutritional supplementation can lead to highly positive economic benefits and improved patient outcomes."
The study’s authors were able to determine differences in length of stay and costs by comparing hospital stays where oral nutritional supplements were prescribed to patients with similar conditions where oral nutritional supplements weren't prescribed.
"Because oral nutritional supplements are formulated to provide advanced nutrition and calories for patients and are relatively inexpensive to provide, the sizeable savings they generate make supplementation a cost-effective therapy," said study co-author, Tomas Philipson Ph.D., Daniel Levin Chair of Public Policy at the University of Chicago.
The retrospective analysis utilized information from more than one million adult inpatient cases found in the Premier Research Database from 2000 - 2010, maintained by the Premier healthcare alliance - representing a total of 44 million hospital episodes from across the United States or approximately 20 percent of all inpatient admissions in the United States. The full sample consisted of adults 18 years and older and focused on oral feeding interventions only. The matched sample ultimately included: 1,160,088 total episodes (oral nutritional supplements episodes N= 580,044 and non-oral nutritional supplements episodes N=580,044), where propensity score matching and instrumental variables were used to address potential bias due to non-random selection.
Low penetration of supplements
The study reflects Abbott’s long-term strategy to both positively affect consumers’ health as well as demonstrate the return on investment for supplement use. "Nearly all of our clinical research studies now include an economic analysis to help demonstrate a nutritional therapy's total value proposition," said Robert H. Miller, PhD, divisional vice president, Global R&D and Scientific Affairs for Abbott Nutrition.
And there is broad scope for that investment, the study found. Despite the benefits of supplementation, the use of oral nutritional supplements was associated with only 1.6% of the 44 million individual records the researchers combed through.
Room for improvement exists at the primary care level, too. A recent study conducted by the University of California Los Angeles found that the number of consumers who talk to their primary care physicians about supplement use is slowly increasing, but discussions remain ‘sparse’.
Analysis of transcripts of audio recordings from office visits by 1,477 patients to 102 primary care providers indicated that 37% of visits included a discussion of dietary supplements in 2009-2010, up from 22% in 1998-99.
Published online by AJMC, Feb. 13, 2013