title: Interdisciplinary management of infantile short bowel syndrome: resource consumption, growth, and nutrition.
abstract: OBJECTIVE
  To date, there are hardly any data on the treatment costs of infantile short bowel syndrome (SBS), despite growing interest in evidence-based and cost-effective medicine. Therefore, the aim of the study was to evaluate resource consumption and costs, next to studying nutritional and growth outcomes, in children with SBS who were treated by an interdisciplinary short bowel team.
  
  
  METHODS
  Data were collected for 10 children with infantile SBS (<or=1 year of age) born between 2002 and 2007. Data included demographic and medical data of the first admission and data on resource consumption, growth, and type of nutrition for the total follow-up period. Real economic costs were calculated in Euro (euro) and US dollar ($).
  
  
  RESULTS
  Seven of the 10 patients were discharged with home parenteral nutrition. Total follow-up varied between 9 months and 5.5 years (median, 1.5 years). Six patients could be weaned off parenteral nutrition and 5 patients off enteral tube feeding, resulting in full oral intake. Seven patients had normal growth. Median duration of initial hospital admission was 174 days, and average costs of initial admission amounted to euro166,045 ($218,681). Average total costs were euro269,700 ($355,195), reaching to a maximum of euro455,400 ($599,762). These costs mainly comprised hospital admissions (82%), followed by nutrition (12%), surgical interventions (5%), and outpatient visits (1%).
  
  
  CONCLUSIONS
  This study is among the first to describe resource consumption and costs in infants with SBS, examining real economic costs and extending beyond the initial hospitalization. Treatment of SBS requires considerable resource consumption, especially when patients depend on parenteral nutrition. Because the costs mainly comprise those of hospital admissions, early home parenteral nutrition could contribute to costs reduction. Interdisciplinary teams have the potential to facilitate early home parenteral nutrition and thus may reduce health care costs.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands. j.olieman@erasmusmc.nl
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Olieman
authors.forename: Marten J
authors.initials: MJ
authors.lastname: Poley
authors.forename: Saskia J
authors.initials: SJ
authors.lastname: Gischler
authors.forename: Corine
authors.initials: C
authors.lastname: Penning
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Escher
authors.forename: Thelma L
authors.initials: TL
authors.lastname: van den Hoonaard
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.forename: Nikolaas M A
authors.initials: NM
authors.lastname: Bax
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Hanneke
authors.initials: H
authors.lastname: IJsselstijn
mesh_terms: D002657:Child Development / Q000502:physiology; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004750:Enteral Nutrition / Q000191:economics* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D009751:Nutritional Requirements; D010288:Parenteral Nutrition / Q000191:economics* / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration; D011446:Prospective Studies; D018570:Risk Assessment; D012778:Short Bowel Syndrome / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D016896:Treatment Outcome