Preoperative immunonutrition: cost-benefit analysis.
BACKGROUND
To evaluate whether preoperative immunonutrition might lead to a savings in patient care. Data on resources consumed to treat postoperative complications are scanty, but morbidity costs continue to be a major burden for any health care system. A recent randomized clinical trial carried out in well-nourished patients with gastrointestinal cancer showed that a 5-day preoperative oral immunonutrition reduced postoperative morbidity compared with conventional treatment (no supplementation).


METHODS
The abovementioned trial was the basis for the economic evaluation. In-hospital related costs of routine surgical care and costs of nutrition were calculated. Estimates of complication costs were based on both resources used for treatment and additional length of hospital stay. Cost comparison and cost-effectiveness analysis were then carried out.


RESULTS
Total cost of nutrition was 3407 euro in the conventional group and 14,729 euro in the preoperative group. In patients without complication, the cost of in-hospital routine care was similar in both groups. The mean cost of complication was 6178 euro in the conventional group and 4639 euro in the preoperative group (p = .05). Total cost of patients with complications was 535,236 euro in the conventional group and 334,148 euro in the preoperative group. Total costs consumed 93% of the diagnosis-related-group (DRG) reimbursement rate in the conventional group and 78% in the preoperative group. Cost-effectiveness was 6245 euro for the conventional group and 2985 euro for the preoperative group.


CONCLUSIONS
The costs of postoperative morbidity consumed a large amount of the DRG reimbursement rate. Preoperative immunonutrition was cost-effective in our series.
Braga
Marco
M
Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy. braga.marco@hsr.it
Gianotti
Luca
L
D003362:Cost-Benefit Analysis; D004032:Diet / Q000145:classification* / Q000191:economics; D019587:Dietary Supplements / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D007167:Immunotherapy / Q000191:economics; D007902:Length of Stay; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D016032:Randomized Controlled Trials as Topic