Cost-effectiveness of nutritional intervention in elderly subjects after hip fracture. A randomized controlled trial

Abstract

Hip fracture patients can benefit from nutritional supplementation during their recovery. Up to now, cost-effectiveness evaluation of nutritional intervention in these patients has not been performed. Costs of nutritional intervention are relatively low as compared with medical costs. Cost-effectiveness evaluation shows that nutritional intervention is likely to be cost-effective.

Introduction: Previous research on the effect of nutritional intervention on clinical outcome in hip fracture patients yielded contradictory results. Cost-effectiveness of nutritional intervention in these patients remains unknown. The aim of this study was to evaluate cost-effectiveness of nutritional intervention in elderly subjects after hip fracture from a societal perspective.

Methods: Open-label, multi-centre randomized controlled trial investigating cost-effectiveness of intensive nutritional intervention comprising regular dietetic counseling and oral nutritional supplementation for 3 months postoperatively. Patients allocated to the control group received care as usual. Costs, weight and quality of life were measured at baseline and at 3 and 6 months postoperatively. Incremental cost-effectiveness ratios (ICERs) were calculated for weight at 3 months and quality adjusted life years (QALYs) at 6 months postoperatively.

Results: Of 152 patients enrolled, 73 were randomized to the intervention group and 79 to the control group. Mean costs of the nutritional intervention was 613 Euro. Total costs and subcategories of costs were not significantly different between both groups. Based on bootstrapping of ICERs, the nutritional intervention was likely to be cost-effective for weight as outcome over the 3-month intervention period, regardless of nutritional status at baseline. With QALYs as outcome, the probability for the nutritional intervention being cost-effective was relatively low, except in subjects aged below 75 years.

Conclusion: Intensive nutritional intervention in elderly hip fracture patients is likely to be cost-effective for weight but not for QALYs. Future cost-effectiveness studies should incorporate outcome measures appropriate for elderly patients, such as functional limitations and other relevant outcome parameters for elderly.

Fig. 1

Cost-effectiveness acceptability curve presenting the probability that the nutritional intervention is cost-effective (y-axis) for weight increase, given various ceiling ratios for willingness to pay (x-axis)

Fig. 2

Cost-effectiveness acceptability curve presenting the probability that the nutritional intervention is cost-effective (y-axis) for QALY, given various ceiling ratios for willingness to pay (x-axis)

Fig. 3

Cost-effectiveness acceptability curve presenting the probability that the nutritional intervention is cost-effective (y-axis), given various ceiling ratios for willingness to pay (x-axis) with respect to weight increase. Sensitivity analyses performed for age groups and nutritional status at baseline, according to the Mini Nutritional Assessment (MNA)

Fig. 4

Cost-effectiveness acceptability curve presenting the probability that the nutritional intervention is cost-effective (y-axis), given various ceiling ratios for willingness to pay (x-axis) with respect to QALY. Sensitivity analyses performed for age groups and nutritional status at baseline, according to the Mini Nutritional Assessment (MNA)