Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a full economic analysis of a multicenter randomized controlled trial based on US costs

Abstract

PurposeThe provision of early enteral (gut) nutrition to critically ill patients, started within 24 hours of injury or intensive care unit admission, is accepted to improve health outcomes. However, not all patients are able to receive early enteral nutrition. The purpose of the economic analysis presented here was to estimate the cost implications of providing early parenteral (intravenous) nutrition to critically ill patients with short-term relative contraindications to early enteral nutrition.Materials and methodsFrom the perspective of the US acute care hospital system, a cost-minimization analysis was undertaken based on large-scale Monte Carlo simulation (N = 1,000,000 trials) of a stochastic model developed using clinical outcomes and measures of resource consumption reported in a 1,363-patient multicenter clinical trial combined with cost distributions obtained from the published literature. The mean costs of acute care attributable to each study group (early parenteral nutrition versus pragmatic standard care) and the mean cost difference between groups, along with respective 95% confidence intervals, were obtained using the percentile method.Results and conclusionThe use of early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition may significantly and meaningfully reduce total costs of acute hospital care by US$3,150 per patient (95% confidence interval US$1,314 to US$4,990). These findings were robust, with all sensitivity analyses demonstrating significant savings attributable to the use of early parenteral nutrition, including sensitivity analysis conducted using European cost data.

Homeostasis alteration within small intestinal mucosa after acute enteral refeeding in total parenteral nutrition mouse model

“…In the critical care setting, the use of early parenteral nutrition has been well-demonstrated to benefit patients who would otherwise have not received enteral nutrition until day 3 of ICU admission, resulting in reduced mechanical ventilation needs, improved quality of life, and reduced costs (9,10). These findings have recently been confirmed in the CALORIES trial, a large randomized trial that found no significant difference in infectious complications or 30-day mortality between early initiation of parenteral vs. enteral nutrition among the critically ill (22).…”

Timing and Indication for Parenteral Nutrition in the Critically Ill

“…And fi nally, there was a statistically signifi cant difference in perceived quality of life at 60 days by early PN, but the difference was so small that it was judged clinically meaningless by the investigators. The authors also published a model based health economy analysis in order to predict possible cost reductions with early PN based on the estimated clinical effect size [ 21 ]. In this model, early PN initiation generated a significant reduction of healthcare costs.…”

“…There was no clear benefi t of the intervention in the Early PN trial [ 21 ]. There was an increased incidence and hampered recovery of ICU acquired muscle weakness in the EPaNIC trial [ 31 ].…”

Temporal Trends in the Use of Parenteral Nutrition in Critically Ill Patients

“…34 Finally, increased awareness of catheter-related bloodstream infections, and the requirement to report such infections, 35 could heighten awareness of the risks of parenteral nutrition and deter use.…”