Nutrition Therapy Cost Analysis in the US

Abstract

BackgroundBloodstream infections (BSI) occur in up to 350 000 inpatient admissions each year in the US, with BSI rates among patients receiving parenteral nutrition (PN) varying from 1.3% to 39%. BSI-attributable costs were estimated to approximate $US12000 per episode in 2000. While previous studies have compared the cost of different PN preparation methods, this analysis evaluates both the direct costs of PN and the treatment costs for BSI associated with different PN delivery methods to determine whether compounded or manufactured pre-mixed PN has lower overall costs.ObjectiveThe purpose of this study was to compare costs in the US associated with compounded PN versus pre-mixed multi-chamber bag (MCB) PN based on underlying infection risk.MethodsUsing claims information from the Premier Perspective™ database, multivariate logistic regression was used to estimate the risk of infection. A total of 44 358 hospitalized patients aged ≥18 years who received PN between 1 January 2005 and 31 December 2007 were included in the analyses. A total of 3256 patients received MCB PN and 41 102 received compounded PN. The PN-associated costs and length of stay were analysed using multivariate ordinary least squares regression models constructed to measure the impact of infectious events on total hospital costs after controlling for baseline and clinical patient characteristics.ResultsThere were 7.3 additional hospital days attributable to BSI. After adjustment for baseline variables, the probability of developing a BSI was 30% higher in patients receiving compounded PN than in those receiving MCB PN (16.1% vs 11.3%; odds ratio= 1.56; 95% CI 1.37, 1.79; p<0.0001), demonstrating 2172 potentially avoidable infections. The observed daily mean PN acquisition cost for patients receiving MCB PN was $US164 (including all additives and fees) compared with $US239 for patients receiving compounded PN (all differences p < 0.001). With a mean cost attributable to BSI of $US16 141, the total per-patient savings (including avoided BSI and PN costs) was $US1545.ConclusionIn this analysis of real-world PN use, MCB PN is associated with lower costs than compounded PN with regards to both PN acquisition and potential avoidance of BSI. Our base case indicates that $US1545 per PN patient may be saved; even if as few as 50% of PN patients are candidates for standardized pre-mix formulations, a potential savings of $US773 per patient may be realized.

The impact of parenteral nutrition preparation on bloodstream infection risk and costs

“…In another study, patients receiving MCB incurred lower health-care costs compared with the compounded PN group. 23 Given the retrospective design of this study, we were only able to assess variables that were included within the patient's medical chart and on our CRFs. Therefore, if patients received central line catheter placement before their admission, their central line catheter was undocumented.…”

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

“…Compared with previous economic analyses assessing the costs of nutrition therapy, which have largely been based on evidence of effectiveness of questionable methodological quality and taken a narrow focus on upfront acquisition costs,20 our CMA is based on the results of a multicenter clinical trial conducted in a focused patient population10 using published costs obtained from comprehensive databases with a broad perspective 14,15. Although our findings of significant and substantial cost savings may appear to conflict with a recent economic analysis reporting increased costs attributable to parenteral nutrition,19 this previously published economic analysis addressed a different clinical indication for parenteral nutrition than did our CMA.…”

“…Furthermore, these US cost estimates, and the cost estimates for parenteral nutrition, were generated from robust databases containing tens of thousands of transactions fromhundreds of hospitals 14,15…”

“…The cost of delivering 1 day of parenteral nutrition therapy in the US market was obtained from the publication by Turpin et al14 Using a transaction level cost database from the Premier Healthcare Alliance, which covers more than 400 hospitals in the USA, Turpin et al identified a total of 44,358 patients from 194 hospitals who had at least one transactional level cost recorded for parenteral nutrition whilst in hospital. The costs for 1 day of parenteral nutrition therapy, including all additives (vitamins, minerals, trace elements, etc) and all fees, were reported as US$186.92 for treatment with a ready-to-mix multi-chamber bag and US$272.40 for a pharmacy compounded bag of parenteral nutrition.…”

Effect of a Comprehensive Total Parenteral Nutrition Training Program on Knowledge and Practice of Nurses in NICU

“…According to this study, it was determined that the frequency, severity, and extent of medication errors in all hospital wards demonstrated that parenteral nutrition mistakes were considered as risky medication errors (Turpin et al, 2011).…”