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10th December 2015

Money, money, money

Malnutrition-costsReaders of this blog will know that malnutrition is a common clinical, public health and economic problem. But do we know what that cost is in terms of pounds and pence?

‘The cost of malnutrition in England and potential cost savings from nutritional interventions’ the result of collaborative research by the  National Institute for Health Research (NIHR) and the British Association for Parenteral and Enteral Nutrition (BAPEN) has just been published.

The report was divided in two parts; the first looking at the cost of malnutrition in England (2011-12), and the second looking at the cost impact of following the National Institute for Health and Care Excellence (NICE) Clinical Guidelines and  Quality Standard (NICE CG/QS) relating to treating malnutrition in adults.

The cost of malnutrition

This report estimated the cost of malnutrition to be a staggering £19.6 million, or more than 15% of the total public expenditure on health and social care . Most of this expenditure was due to healthcare, rather than social care, secondary rather than primary healthcare, and predominantly older adults rather than children.

The large contribution of institutionalised care to total costs was not only due to the high cost of institutionalisation, but also the high point prevalence of malnutrition in hospitals. However, only 2% of malnourished subjects are found in hospital at a given moment in time. This reflects relatively low occupation, some 136,332 hospital beds, of which only a proportion are malnourished. Most malnutrition is in fact harboured in the community followed by care homes, which have several more times occupied beds than hospitals. But the high turnover of hospital patients in an expensive hospital environment explains the high contribution of hospitals to overall costs.

Since most malnutrition originates and exists outside hospital and care homes, preventative measures should be taken in the community. In other words, malnutrition is not just a problem in hospitals or in care homes or in the community, but runs across all three, and an integrated and coordinated system to prevention and treatment of malnutrition is important.

Cost impact analysis involving NICE Guidance

The cost analysis was undertaken using a model that involved 3 steps; calculation of the investment needed to change the current nutrition care pathway to one incorporating the NICE CG/QS, calculating the cost saving arising from using the appropriate pathway, and the overall net cost saving, calculated as the difference between the two steps.  Since the NICE CG/QS involve screening, assessment and treatment in hospitals, care homes and the community all 3 settings were included in the calculation.

Findings of cost savings

Interventions to implement NICE CG/QS in hospital and community settings were found to lead to net cost savings of £172.2 – £229.2 million, based on applying the NICE CG/QS to 85% of adults with medium or high risk of malnutrition.

There are some limitations in this report, including that only a small fraction of malnourished populations were considered (for example, only new admissions to care homes), and only NHS costs were considered.  The authors conclude that it is likely that improvement of identification and treatment of malnutrition in every social care and health setting would result in even greater overall costs savings, whilst improving clinical outcomes and the quality of services.

Understanding that appropriate nutritional support can save rather than cost money has major implications to commissioners, health and social care providers, and the public.

Ayela Spiro, British Nutrition Foundation – QCS Expert Nutrition Contributor

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