title: Cost-effectiveness analysis of an enteral nutrition protocol for children with common gastrointestinal diseases in China: good start but still a long way to go.
abstract: BACKGROUND
  A standard nutrition screening and enteral nutrition (EN) protocol was implemented in January 2012 in a tertiary children's center in China. The aims of the present study were to evaluate the cost-effectiveness of a standard EN protocol in hospitalized patients.
  
  
  METHODS
  A retrospective chart review was performed in the gastroenterology inpatient unit. We included all inpatient children requiring EN from January 1, 2010, to December 31, 2013, with common gastrointestinal (GI) diseases. Children from January 1, 2012, to December 31, 2013, served as the standard EN treatment group, and those from January 1, 2010, to December 31, 2011, were the control EN group. Pertinent patient information was collected. We also analyzed the length of hospital stay, cost of care, and in-hospital infection rates.
  
  
  RESULTS
  The standard EN treatment group received more nasojejunal tube feedings. There was a tendency for the standard EN treatment group to receive more elemental and hydrolyzed protein formulas. Implementation of a standard EN protocol significantly reduced the time to initiate EN (32.38 ± 24.50 hours vs 18.76 ± 13.53 hours; P = .011) and the time to reach a targeted calorie goal (7.42 ± 3.98 days vs 5.06 ± 3.55 days; P = .023); length of hospital stay was shortened by 3.2 days after implementation of the standard EN protocol but did not reach statistical significance. However, the shortened length of hospital stay contributed to a significant reduction in the total cost of hospital care (13,164.12 ± 6722.95 Chinese yuan [CNY] vs 9814.96 ± 4592.91 CNY; P < .032).
  
  
  CONCLUSIONS
  Implementation of a standard EN protocol resulted in early initiation of EN, shortened length of stay, and significantly reduced total cost of care in hospitalized children with common GI diseases.
authors.affiliation: Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
authors.forename: Min
authors.initials: M
authors.lastname: Yang
authors.affiliation: Graduate School of Jinan University, Guangzhou, China.
authors.forename: Pei-Yu
authors.initials: PY
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
authors.forename: Si-Tang
authors.initials: ST
authors.lastname: Gong
authors.affiliation: Division of Gastroenterology, Children's Mercy Hospital, University of Missouri School of Medicine, Kansas City, Missouri.
authors.forename: Beth
authors.initials: B
authors.lastname: Lyman
authors.affiliation: Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
authors.forename: Lan-Lan
authors.initials: LL
authors.lastname: Geng
authors.affiliation: Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
authors.forename: Cui-Ping
authors.initials: CP
authors.lastname: Liang
authors.affiliation: Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
authors.forename: Zhao-Hui
authors.initials: ZH
authors.lastname: Xu
authors.affiliation: Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
authors.forename: Hui-Wen
authors.initials: HW
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
authors.forename: Tie-Fu
authors.initials: TF
authors.lastname: Fang
authors.affiliation: Division of Gastroenterology, Children's Mercy Hospital, University of Missouri School of Medicine, Kansas City, Missouri dyli@cmh.edu.
authors.forename: Ding-You
authors.initials: DY
authors.lastname: Li
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002681:China; D002985:Clinical Protocols / Q000592:standards; D003362:Cost-Benefit Analysis; D004750:Enteral Nutrition / Q000191:economics*; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics*; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: children; cost-effectiveness; enteral nutrition