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Managing malnutrition - BAPEN report

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Managing malnutrition - BAPEN report

BAPEN have produced a report that explains why malnutrition costs so much and highlights the importance of identifying and appropriately managing malnutrition, as well as the cost savings that can be achieved by better management of this issue.

Read the full report here.

Key points

Malnutrition is a public health problem, estimated to cost at least £19.6 billion in England (£23.5 billion in the UK), which is about 15% of the total expenditure on health and social care. Most of the costs of malnutrition are in health care (£15.2bn), mostly secondary care, with £4bn from social care. The costs of malnutrition are likely to rise in the future as the population ages.

Older adults (aged 65 years and over) account for 52% of the total costs of malnutrition, with the remainder from younger adults (<65 years) and children. The annual health and social costs are estimated to be 3x greater for a malnourished patient (£7408) than a non malnourished patient (£2155).

The costs of malnutrition are high as:

1. Malnutrition is common across health and social care settings in those with disease, and in older people.

2. Malnutrition continues to be under-identified and under-treated.

3. Malnutrition has adverse effects if unidentified and untreated. The consequences of untreated malnutrition include physical and functional decline and poorer clinical outcomes (e.g. increased infections, wounds, complications, mortality), leading to greater health care use (hospital (re)admissions, longer hospital stays, more GP visits, increased prescription costs). The expenditure on treatments and strategies to identify and manage malnutrition is a very small proportion of the overall costs of malnutrition (<2.5%).

Research, national NICE guidance and clinical pathways highlight the importance of:

1. Malnutrition screening with a validated tool (e.g. Malnutrition Universal Screening Tool ‘MUST’) to identify malnutrition and initiate a treatment plan, whilst identifying and managing the underlying cause.

2. Managing malnutrition in a timely and evidence-based way with nutritional support, such as the appropriate prescription of oral nutritional supplements for those patients at high risk of malnutrition who can be managed orally, and use of enteral tube feeding and/or parenteral nutrition where indicated. Dietitians can provide expert dietary advice and guidance on all strategies for managing malnutrition.

Identifying malnutrition (with screening) and effectively managing this condition can improve lives and save money. Research confirms the benefits of managing malnutrition with nutritional support, such as the use of oral nutritional supplements alongside the diet, resulting in improvements in patients’ function (e.g. strength), quality of life and clinical outcomes, and reductions in health care use (e.g. hospital stays, admissions).

Economic analysis shows that identifying and treating malnutrition can save at least ~£123,530 per 100,000 people, a ~£65m net saving for England. A large proportion of these estimated savings arises from the clinical and cost effectiveness of oral nutritional supplements, reducing health care use. The economic analyses of both NICE and BAPEN show that managing malnutrition with nutritional support according to NICE CG32/QS24 is highly cost effective, and compares favourably with other interventions in clinical practice.