title: Effectiveness and cost-effectiveness of supplemental glutamine dipeptide in total parenteral nutrition therapy for critically ill patients: a discrete event simulation model based on Italian data.
abstract: BACKGROUND
  The supplementation of alanyl-glutamine dipeptide in critically ill patients necessitating total parenteral nutrition (TPN) improves clinical outcomes, reducing mortality, infection rate, and shortening intensive care unit (ICU) hospital lengths of stay (LOSs), as compared to standard TPN regimens.
  
  
  METHODS
  A Discrete Event Simulation model that incorporates outcomes rates from 200 Italian ICUs for over 60,000 patients, alanyl-glutamine dipeptide efficacy data synthesized by means of a Bayesian random effects meta-analysis, and national cost data has been developed to evaluate the alternatives from the cost perspective of the hospital. Simulated clinical outcomes are death and infection rates in ICU, death rate in general ward, and hospital LOSs. Sensitivity analyses are performed by varying all uncertain parameter values in a plausible range.
  
  
  RESULTS
  The internal validation process confirmed the accuracy of the model in replicating observed clinical data. Alanyl-glutamine dipeptide on average results more effective and less costly than standard TPN: reduced mortality rate (24.6% ± 1.6% vs. 34.5% ± 2.1%), infection rate (13.8% ± 2.9% vs. 18.8% ± 3.9%), and hospital LOS (24.9 ± 0.3 vs. 26.0 ± 0.3 days) come at a lower total cost per patient (23,409 ± 3,345 vs. 24,161 ± 3,523 Euro).Treatment cost is completely offset by savings on ICU and antibiotic costs. Sensitivity analyses confirmed the robustness of these results.
  
  
  CONCLUSIONS
  Alanyl-glutamine dipeptide is expected to improve clinical outcomes and to do so with a concurrent saving for the Italian hospital.
authors.affiliation: Adres Health Economics. l.pradelli@adreshe.com
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pradelli
authors.forename: Sergio
authors.initials: S
authors.lastname: Iannazzo
authors.forename: Orietta
authors.initials: O
authors.lastname: Zaniolo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muscaritoli
authors.forename: Mario
authors.initials: M
authors.lastname: Eandi
mesh_terms: D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016638:Critical Illness / Q000191:economics*; D019587:Dietary Supplements / Q000191:economics* / Q000706:statistics & numerical data; D005973:Glutamine / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D018803:Models, Economic; D010289:Parenteral Nutrition, Total / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D019282:Wasting Syndrome / Q000178:diet therapy* / Q000191:economics
chemical_list: D005973:Glutamine