The economic costs of home parenteral nutrition: Systematic review of partial and full economic evaluations

Arhip, L.; Serrano-Moreno, Clara; Romero, Irma; Camblor, M.; Cuerda, C.

doi:10.1016/j.clnu.2020.06.010

Cited by 28 publications

(28 citation statements)

References 37 publications

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“…However, we observed a wide range in annual costs both between and within patients, covering a range of £1804 to £331,489 per patient year. We found that inpatient bed, pharmacy (including PN), and staffing costs are the main drivers of total hospital-based cost per patient-year, which is consistent with the findings of a recent systematic review and emphasize the advantage of avoiding hospital admission in SBS patients while investing in home care [ 10 ].…”

Section: Discussionsupporting

confidence: 88%

“…Therefore, subsequent use of our study methodology and PLICS data will allow future studies to estimate the potential resource savings from the prevention of acute admissions. Ideally, such data can be used in building business cases for the development of programmes in the community to avoid complications requiring admission to hospital, as home PN has already been shown to be 60–76% less costly than in-hospital PN [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most cost of care analyses for SBS focus on adult patients or mixed populations in which paediatric patients are not analysed separately [ 10 ]. The most robust assessment of comprehensive care in paediatric SBS was undertaken by the Teitelbaum group in Michigan, USA [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Patient-level costing analysis of paediatric short bowel syndrome care in a specialist tertiary centre

et al. 2022

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Purpose To undertake a pilot study estimating patient-level costs of care for paediatric short bowel syndrome (SBS) from the healthcare provider perspective. Methods A pilot group of patients with anatomical SBS was selected at a single specialist tertiary centre in the United Kingdom. The Patient Level Information and Costing System (PLICS) was used to extract costing data for all hospital-based activities related to SBS, from the implementation of PLICS in 2016 to April 2021. Patient-specific and pooled data were reported descriptively in per patient-year terms. Results Five patients had full PLICS data available for the 5-year study period and 2 patients had 4 years of data. The median cost for hospital care of SBS was £52,834 per patient-year (range £1804–£331,489). The key cost drivers were inpatient beds, pharmacy, and staffing costs, which made up > 60% of annual costs. In the first 3 years following index admission (n = 2), there was a steady decline in the annual cost of care to a level comparable with patients with established SBS. Conclusion Patient-level cost of care analysis for SBS is feasible using PLICS. Hospital-related costs vary widely between and within individual patients over time. Key drivers of cost are related to complications of SBS.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Patient-level costing analysis of paediatric short bowel syndrome care in a specialist tertiary centre

et al. 2022

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“…These results highlight that the economic costs for the health service provider in maintaining the health and well‐being of IF patients are substantial and the shortfall is problematic for efficient service management. Findings from this study are similarly reported in a literature review of 21 economic evaluations for HPN, 13 where it was considered overall to be a more expensive treatment but cost‐saving when compared with hospital‐based PN. Reasons behind this high cost are that patients require a specialist and wide‐ranging scope of health professionals to address all aspects of care 18,19 .…”

Section: Discussionsupporting

confidence: 74%

Detailed analysis of in‐hospital costs for adult patients with type III intestinal failure: A single‐center study with global implications

Siu

Carey

Jones

et al. 2021

J Parenter Enteral Nutr

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Background Home parenteral nutrition (HPN) is the recommended treatment for patients with type III intestinal failure (IF). However, owing to IF's rarity, the economic cost of managing these patients is not well understood. These patients often develop complications resulting in readmissions, which in turn contribute to ongoing costs. This study aims to document the costs of type III IF within the hospital, from initial admission, including readmissions, and to compare incurred costs with current government reimbursement. Methods A retrospective study design reviewed costs and reimbursement for 25 consecutive patients commencing HPN at a quaternary hospital (October 2011 to September 2017). Hospital admissions were separated into the initial admission and readmission(s) period. Healthcare use and cost data were collected using electronic medical records. Hospital reimbursement costs were retrieved from Sydney Local Health District's Targeted Activity and Reporting Systems. Patient demographics were tabulated, and healthcare use and cost data were compared using Wilcoxon signed rank tests. Results The median cost of the initial hospital admission was substantially higher than the median reimbursement ($36,675; interquartile range [IQR], $23,196–$67,439 vs $19,247; IQR, $7485–$41,090; P < .001). Similar results were observed in the readmissions period, with median incurred costs of $13,898; (IQR, $11,151–$32,130) vs reimbursement of $8469 (IQR, $5625–$13,078) (P = .001). Conclusion Results indicate that type III IF patients have high inpatient costs, which substantially outweigh current reimbursement. Improved funding models are needed to ensure hospitals that accept the management challenge of type III IF patients are not unduly penalized.

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“…A recent systematic review on costs of HPN showed that it is very problematic to compare the data between countries due to different methodologies and high heterogeneity of the studies. Most studies included only direct costs and were designed from a health care perspective [8]. Direct healthcare costs (ex.…”

Section: Introductionmentioning

confidence: 99%

Trend Observations in Home Parenteral Nutrition. Prevalence, Hospitalizations and Costs: Results from a Nationwide Analysis of Health Care Provider Data

Folwarski

Kłęk

Szlagatys-Sidorkiewicz

et al. 2021

Nutrients

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Background: The population of patients on home parenteral nutrition (HPN) worldwide is growing. Since only a few counties provide data from national registries long-term observations are valuable to address this specific area of nutrition support. This study is a nationwide analysis determining the trends in the epidemiology of HPN (prevalence, age distribution, death rates), indications for HPN, causes for hospitalizations, and cost analysis of HPN reimbursement in Poland between 2010–2020. Methods: A retrospective analysis of data obtained from the national health fund (NHF) of Poland on adult patients on HPN. Results: The prevalence of adult patients on HPN in Poland in 2020 was 53.26 per million citizens with a 2.99-fold increase and a growing trend observed from 2010. Significant decrease in the percentage of patients between 18–34, 45–54 and an increase in patients between 65–74 and patients over 75 years old was observed. Trend analysis showed an increase in new patients between 65–74 and a decrease between 35–54. Malnutrition (34.28%), postprocedural disorders of the GI tract (19.61%), intestinal malabsorption/other intestinal diseases (20.41%) and GI obstruction due to cancer (17.36% as primary and 23.16% as secondary diagnosis) were mostly reported as the primary indications for HPN. Cancer patients were mostly gastric, ovarian and colon cancer (34.74%, 17.83% and 12.3%). HPN and total health cost reimbursement increase was 2.6 and 2.57—fold respectively. Costs of HPN and total health care costs in 2020 per patient were € 10,015 and € 16,038, respectively. Overall death risk rate during the first year of nutrition was 0.59 with a significant increase in the observation period p-trend < 0.004. A significant increase in the death rate was observed in patients above 75 years old (estimate 1.629, p-trend < 0.030). Cancer, infection, malnutrition and GI symptoms were the most common indications for hospitalizations of HPN patients. The rate of patients with a maximal length of HPN of 5 months in 2010 was 54.9% and was growing up to 78.1% in 2020. Conclusions: The prevalence of HPN in Poland is growing. Trends of age distribution show increasing numbers of patients with more advanced age and shorter survival. Costs of HPN are comparable with other European data.

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The economic costs of home parenteral nutrition: Systematic review of partial and full economic evaluations

Cited by 28 publications

References 37 publications

Patient-level costing analysis of paediatric short bowel syndrome care in a specialist tertiary centre

Patient-level costing analysis of paediatric short bowel syndrome care in a specialist tertiary centre

Detailed analysis of in‐hospital costs for adult patients with type III intestinal failure: A single‐center study with global implications

Trend Observations in Home Parenteral Nutrition. Prevalence, Hospitalizations and Costs: Results from a Nationwide Analysis of Health Care Provider Data

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