title: Intestinal rehabilitation for children with intestinal failure is cost-effective: a simulation study.
abstract: Children with intestinal failure (IF) depend on parenteral nutrition (PN). The goal in the treatment of IF is to wean children off PN through intestinal rehabilitation (IR). Although the healthcare burden of IF is enormous, to our knowledge there has been no previous cost-effectiveness analysis in pediatric IF including IR.
  
  
  
  We sought to determine the cost-effectiveness of IR in terms of costs and life-years.
  
  
  
  We simulated the treatment of IF in children in a discrete-event model. Data for this model were derived from patient records, the Dutch Registry of Intestinal Failure and Transplantation, the Intestinal Transplant Registry, and the literature. The time horizon of the model was 40 y. Simulated patients were enrolled at a rate of 40 patients/mo for 10 y. Actual costs were calculated for hospital admissions, surgical interventions, endoscopies, PN, and immunosuppressive medication. We evaluated the cost-effectiveness of IR by comparing 1 scenario with IR with 1 scenario without IR. In the scenario with IR, a proportion of patients who represented those with the ability to wean off PN were assigned to IR. In the scenario without IR, all patients progressed to home PN (HPN). In both scenarios, a proportion of patients receiving HPN were eventually eligible for an intestinal transplantation.
  
  
  
  IR prolonged survival; the mean number of life-years per patient was 19.4 in the scenario with IR compared with 18.2 in the scenario without IR. Average total costs per patient were €819,292 in the scenario with IR compared with €1,176,830 in the scenario without IR (equivalent to 1,129,230 US$ and 1,622,025 US$, respectively, in January 2014); costs mainly included hospital admissions and PN.
  
  
  
  On the basis of our simulations, we concluded that IR improved the survival of children with IF and was associated with cost savings. Therefore, we consider IR to be a cost-effective treatment for children with IF.
authors.affiliation: Departments of Epidemiology and.
authors.forename: Henk
authors.initials: H
authors.lastname: Groen
authors.affiliation: Departments of Pediatric Gastroenterology and e.neelis@erasmusmc.nl.
authors.forename: Esther G
authors.initials: EG
authors.lastname: Neelis
authors.affiliation: Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.|Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands.
authors.forename: Marten J
authors.initials: MJ
authors.lastname: Poley
authors.affiliation: Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.|Department of Dietetics, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Olieman
authors.affiliation: Department of Pediatric Gastroenterology, University of Groningen, University Medical Center Groningen-Beatrix Children's Hospital, Groningen, Netherlands; and.
authors.forename: René
authors.initials: R
authors.lastname: Scheenstra
authors.affiliation: Departments of Epidemiology and.
authors.forename: Paul Fm
authors.initials: PF
authors.lastname: Krabbe
authors.affiliation: Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Dijkstra
authors.affiliation: Departments of Pediatric Gastroenterology and.|Department of Pediatrics, Leiden University Medical Center-Willem Alexander Children's Hospital, Leiden, Netherlands.
authors.forename: Edmond Hhm
authors.initials: EH
authors.lastname: Rings
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007410:Intestinal Diseases / Q000191:economics / Q000534:rehabilitation*; D007413:Intestinal Mucosa / Q000378:metabolism*; D007422:Intestines / Q000503:physiopathology; D016331:Parenteral Nutrition, Home / Q000191:economics; D010289:Parenteral Nutrition, Total / Q000191:economics*; D012042:Registries; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: (home) parenteral nutrition; cost-effectiveness; intestinal failure; intestinal rehabilitation; intestinal transplantation