Abstract
Background/Objective: We compared healthcare utilization and cost outcomes for patients before and after they underwent a nutrition care intervention that included daily consumption of specialized or standard oral nutritional supplements (ONS) as part of a multimodal program. We sought to determine whether this nutritional intervention was associated with reduced use of healthcare resources and lowered costs. Methods: This retrospective analysis included adult patients who were referred to the medical nutrition office with malnutrition or its risk. We followed outcomes for patients who had received nutritional interventions (3-6 months) that included diet and exercise recommendations as well as a specialized ONS enriched with β-hydroxy-β-methylbutyrate (HMB-ONS) or a standard ONS (S-ONS). We reviewed hospital records for resource utilization data-hospital (re)admissions, number of days in the hospital, patient visits to the emergency department (ED), and visits to general practitioners (GP) and specialty physician clinics. We compared healthcare utilization for intervals up to 12 months before and after the initiation of the nutrition care intervention. We also examined healthcare utilization and costs as well as changes in oncology treatment following initiations of the nutrition care intervention for a subgroup of cancer patients. Results: Over a 12-month period following the start of nutritional intervention with ONS, the patients had lower healthcare resource use and costs. With daily use of S-ONS or HMB-ONS for up to 6 months, the patients' healthcare utilization was significantly reduced at 3-, 6-, and 12-month time points for hospital admissions, ED visits, GP visits, and specialty visits (all p < 0.001). Overall, ONS use was associated with reduced patient healthcare costs by half (EUR 27,024.80 to EUR 13,349.60, p < 0.001). Significant clinical predictors of higher use of healthcare resources and costs were older age, having positive indications of malnutrition, exhibiting a greater Charlson Comorbidity Index (CCI), and having been hospitalized for oncology surgery. Regression analysis revealed that ONS intervention was associated with lower total healthcare costs (β(Post-ONS) = -0.504), and that patients receiving HMB-ONS (β(ONS-HMB) = -0.583) had a greater reduction in costs than did patients receiving S-ONS in the 12 months after nutritional intervention. Patients with cancer who received HMB-ONS were less likely than those receiving S-ONS to need suspension or dose reduction in oncology drug treatment due to failure or intolerance of the treatment drug. Conclusions: multimodal programs including ONS improve health economic outcomes for patients with poor nutritional status due to disease. Health economic outcome improvements included lower healthcare resource use, lower healthcare costs, and, for patients being treated for cancer, a reduced likelihood of treatment failure. The use of ONS enriched with HMB provided advantages over standard ONS, both in health outcomes and cost-of-care reductions.