title: Cost-effectiveness of omega-3 fatty acid supplements in parenteral nutrition therapy in hospitals: a discrete event simulation model.
abstract: OBJECTIVE
  A recent meta-analysis showed that supplementation of omega-3 fatty acids in parenteral nutrition (PN) regimens is associated with a statistically and clinically significant reduction in infection rate, and length of hospital stay (LOS) in medical and surgical patients admitted to the ICU and in surgical patients not admitted to the ICU. The objective of this present study was to evaluate the cost-effectiveness of the addition of omega-3 fatty acids to standard PN regimens in four European countries (Italy, France, Germany and the UK) from the healthcare provider perspective.
  
  
  METHODS
  Using a discrete event simulation scheme, a patient-level simulation model was developed, based on outcomes from the Italian ICU patient population and published literature. Comparative efficacy data for PN regimens containing omega-3 fatty acids versus standard PN regimens was taken from the meta-analysis of published randomised clinical trials (n = 23 studies with a total of 1502 patients), and hospital LOS reduction was further processed in order to split the reduction in ICU stay from that in-ward stays for patients admitted to the ICU. Country-specific cost data was obtained for Italian, French, German and UK healthcare systems. Clinical outcomes included in the model were death rates, nosocomial infection rates, and ICU/hospital LOS. Probabilistic and deterministic sensitivity analyses were undertaken to test the reliability of results.
  
  
  RESULTS
  PN regimens containing omega-3 fatty acids were more effective on average than standard PN both in ICU and in non-ICU patients in the four countries considered, reducing infection rates and overall LOS, and resulting in a lower total cost per patient. Overall costs for patients receiving PN regimens containing omega-3 fatty acids were between €14 144 to €19 825 per ICU patient and €5484 to €14 232 per non-ICU patient, translating into savings of between €3972 and €4897 per ICU patient and savings of between €561 and €1762 per non-ICU patient. Treatment costs were completely offset by the reduction in hospital stay costs and antibiotic costs. Sensitivity analyses confirmed the robustness of these findings.
  
  
  CONCLUSIONS
  These results suggest that the supplementation of PN regimens with omega-3 fatty acids would be cost effective in Italian, French, German and UK hospitals.
authors.affiliation: AdRes HE&OR, Turin, Italy. Electronic address: l.pradelli@adreshe.com.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pradelli
authors.affiliation: Pharmacology, Università degli Studi di Torino, Via Pietro Giuria 13, I-10100 Torino, Italy. Electronic address: mario.eandi@unito.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Eandi
authors.affiliation: AdRes HE&OR, Turin, Italy. Electronic address: m.povero@adreshe.com.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Povero
authors.affiliation: Lung Transplant Program, Internal Medicine, Pulmonary Medicine, Intensive Care Medicine, Sleep Medicine, Department of Internal Medicine, Justus-Liebig University Giessen, Klinikstrasse 36, D-35392 Giessen, Germany. Electronic address: Konstantin.Mayer@uglc.de.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Mayer
authors.affiliation: Internal Medicine, Università La Sapienza, Via del Policlinico 155, I-00161 Rome, Italy. Electronic address: maurizio.muscaritoli@uniroma1.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muscaritoli
authors.affiliation: Clinic for Anaesthesiology and Intensive Therapy, University Dresden, Fetscherstraße 74, D-01307 Dresden, Germany. Electronic address: Axel.Heller@uniklinikum-dresden.de.
authors.forename: Axel R
authors.initials: AR
authors.lastname: Heller
authors.affiliation: Fresenius Kabi Deutschland GmbH, Rathausplatz 12, D-61348 Bad Homburg, Germany. Electronic address: Eva.Fries-Schaffner@fresenius-kabi.com.
authors.forename: Eva
authors.initials: E
authors.lastname: Fries-Schaffner
mesh_terms: D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000517:prevention & control; D019587:Dietary Supplements / Q000191:economics*; D005060:Europe; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005602:France; D005858:Germany; D017721:Hospital Costs; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D007902:Length of Stay; D018803:Models, Economic; D010288:Parenteral Nutrition / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D006113:United Kingdom
chemical_list: D015525:Fatty Acids, Omega-3
keywords: Cost; Model; Nutrition; Omega-3; Parenteral; Pharmacoeconomics