title: Updated cost-effectiveness analysis of supplemental glutamine for parenteral nutrition of intensive-care patients.
abstract: OBJECTIVE
  Intravenous (i.v.) glutamine supplementation of parenteral nutrition (PN) can improve clinical outcomes, reduce mortality and infection rates and shorten the length of hospital and/or intensive care unit (ICU) stays compared with standard PN. This study is a pharmacoeconomic analysis to determine whether i.v. glutamine supplementation of PN remains both a highly favourable and cost-effective option for Italian ICU patients.
  
  
  METHODS
  A previously published discrete event simulation model was updated by incorporating the most up-to-date and clinically relevant efficacy data (a clinically realistic subgroup analysis from a published meta-analysis), recent cost data from the Italian health-care system and the latest epidemiology data from a large Italian ICU database (covering 230 Italian ICUs and more than 77,000 patients). Sensitivity analyses were performed to test the robustness of the results.
  
  
  RESULTS
  Parenteral glutamine supplementation can significantly improve ICU efficiency in Italy, as the additional cost of supplemented treatment is more than completely offset by cost savings in hospital care. Supplementation was more cost-effective (cost-effectiveness ratio (CER)=[euro ]35,165 per patient discharged alive) than standard, non-supplemented PN (CER=[euro ]40,156 per patient discharged alive), and it resulted in mean cost savings of [euro ]4991 per patient discharged alive or [euro ]1047 per patient admitted to the hospital. Sensitivity analyses confirmed the robustness of these results.
  
  
  CONCLUSIONS
  Alanyl-glutamine supplementation of PN is a clinically and economically attractive strategy for ICU patients in Italy and may be applicable to selected ICU patient populations in other countries.
authors.affiliation: AdRes Health Economics and Outcomes Research, Turin, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pradelli
authors.affiliation: AdRes Health Economics and Outcomes Research, Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Povero
authors.affiliation: Department of Internal Medicine, Università La Sapienza, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Muscaritoli
authors.affiliation: Department of Pharmacology, Università degli Studi di Torino, Torino, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Eandi
mesh_terms: D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D019587:Dietary Supplements / Q000191:economics*; D005973:Glutamine / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007239:Infections / Q000178:diet therapy / Q000453:epidemiology; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010288:Parenteral Nutrition / Q000191:economics* / Q000379:methods
chemical_list: D005973:Glutamine