Early introduction of a semi-elemental formula may be cost saving compared to a polymeric formula among critically ill patients requiring enteral nutrition: a cohort cost–consequence model
Authors Curry AS, Chadda S, Danel A, Nguyen DL
Received 27 October 2017
Accepted for publication 28 March 2018
Published 5 June 2018 Volume 2018:10 Pages 293—300
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 4
Editor who approved publication: Professor Dean Smith
Alistair S Curry,1 Shkun Chadda,1 Aurélie Danel,2 Douglas L Nguyen3
1Health Economics, SIRIUS Market Access, London UK; 2Market Access, Nestlé Health Science, Vevey, Switzerland; 3University of California-Irvine Department of Medicine, Orange, CA, USA
Objectives: Gastrointestinal (GI) intolerance is associated with adverse outcomes in critically ill patients receiving enteral nutrition (EN). The objective of this analysis is to quantify the cost of GI intolerance and the cost implications of starting with semi-elemental EN in intensive care units (ICUs).
Study design: A US-based cost–consequence model was developed to compare the costs for patients with and without GI intolerance and the costs with semi-elemental or standard EN while varying the proportion of GI intolerance cases avoided.
Materials and methods: ICU data on GI intolerance prevalence and outcomes in patients receiving EN were derived from an observational study. ICU stay costs were obtained from literature and the costs of EN from US customers’ price lists. The model was used to conduct a threshold analysis, which calculated the minimum number of cases of GI intolerance that would have to be avoided to make the initial use of semi-elemental formula cost saving for the cohort.
Results: Out of 100 patients receiving EN, 31 had GI intolerance requiring a median ICU stay of 14.4 days versus 11.3 days for each patient without GI intolerance. The model calculated that semi-elemental formula was cost saving versus standard formula when only three cases of GI intolerance were prevented per 100 patients (7% of GI intolerance cases avoided).
Conclusion: In the US setting, the model predicts that initial use of semi-elemental instead of standard EN can result in cost savings through the reduction in length of ICU stay if >7% of GI intolerance cases are avoided.
Keywords: intensive care unit, enteral nutrition, semi-elemental formula, gastrointestinal intolerance, costs
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