Cost-Effectiveness Analyses of Home Parenteral Nutrition for Incurable Gastrointestinal Cancer Patients

Abstract

BackgroundAppropriate nutritional support, including supplemental home parenteral nutrition (sHPN), may improve prognosis and quality of life (Qol) of malnourished cancer patients. We aimed to explore the cost-effectiveness of sHPN for incurable gastrointestinal cancer patients from the Chinese healthcare perspective.MethodClinical data were extracted from a randomized controlled trial (NCT02066363). Patients were randomized into the sHPN group or the non-sHPN group (receiving best practice nutritional care). A Markov model was established with a 6-week cycle length. Costs were acquired from local hospitals, effect parameters included quality-adjusted life year (QALY), Qol, body mass index, fat-free mass (FFM), FFM index, handgrip strength, and a 6-min walking test. Sensitivity analyses were conducted with a willingness-to-pay (WTP) set at 3 per capita gross domestic product ($29,307/QALY).ResultsWhen considering QALY as a utility, the incremental cost-effectiveness ratio (ICER) was $24,289.17, with an incremental cost of $2,051.18 and an incremental QALY of 0.0844 between the sHPN group and the non-sHPN group. Furthermore, we explored the cost-effectiveness of sHPN from multidimensions, where we analyzed various effect parameters at different visits; the results showed a superior benefit for patients in the sHPN group except for the handgrip parameter at visit 2. Sensitivity analysis demonstrated the influence of utilities in the sHPN group, but the sHPN group was still cost-effective with a WTP of $2,500/QALY.ConclusionIn China, sHPN was cost-effective for patients with incurable gastrointestinal cancer, which suggested further applications in clinical practice and provided references for clinical decisions and pricing.

Ready-to-Use Multichamber Bags in Home Parenteral Nutrition for Patients with Advanced Cancer: A Single-Center Prospective Study

“…Home parenteral nutrition (HPN) is an increasing prescribed therapy for patients with advanced cancer, mostly with gastrointestinal or gynecological tumors [1,2]. Several beneficial effects of HPN have been described in these patients: supplemental HPN may prevent the loss of or even increase free-fat mass in patients with incurable gastrointestinal cancer, and positively impact on quality of life [3,4]; survival was significantly correlated with patient characteristics at HPN start and favorable factors produced an increase in survival [5][6][7]; it was also a relevant palliative therapy for patients with advanced cancer without oral-or enteral-feeding access [8]; it provided important clinical and quality of life benefits; and cost-effectiveness was greater in patients with less severe disease [9][10][11]. Therefore, current nutrition guidelines for patients with cancer recommend the use of HPN Nutrients 2024, 16, 457 2 of 11 whenever necessary, especially in those patients without oral-or enteral-feeding access under active oncologic treatment [12][13][14].…”