Supplemental parenteral nutrition in intensive care patients: A cost saving strategy.
The Swiss supplemental parenteral nutrition (SPN) study demonstrated that optimised energy provision combining enteral nutrition (EN) and SPN reduces nosocomial infections in critically ill adults who fail to achieve targeted energy delivery with EN alone. To assess the economic impact of this strategy, we performed a cost-effectiveness analysis using data from the SPN study.



Multivariable regression analyses were performed to characterise the relationships between SPN, cumulative energy deficit, nosocomial infection, and resource consumption. The results were used as inputs for a deterministic simulation model evaluating the cost-effectiveness of SPN administered on days 4-8 in patients who fail to achieve ≥60% of targeted energy delivery with EN by day 3. Cost data were derived primarily from Swiss diagnosis-related case costs and official labour statistics.



Provision of SPN on days 4-8 was associated with a mean decrease of 2320 ± 338 kcal in cumulative energy deficit compared with EN alone (p < 0.001). Logistic regression analysis showed that each 1000 kcal decrease in cumulative energy deficit was associated with a 10% reduction in the risk of nosocomial infection (odds ratio 0.90; 95% confidence interval 0.83-0.99; p < 0.05). The incremental cost per avoided infection was -63,048 CHF, indicating that the reduction in infection was achieved at a lower cost.



Optimisation of energy provision using SPN is a cost-saving strategy in critically ill adults for whom EN is insufficient to meet energy requirements.
AdRes Health Economics and Outcomes Research, Via Vittorio Alfieri, 17, 10121 Turin, Italy. Electronic address: l.pradelli@adreshe.com.
Lorenzo
L
Pradelli
Service des Soins Intensifs, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; Nutrition Unit, Division of Intensive Care, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Genève Switzerland.
Séverine
S
Graf
Nutrition Unit, Division of Intensive Care, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Genève Switzerland.
Claude
C
Pichard
Service of Adult Intensive Care, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne Switzerland.
Mette M
MM
Berger
D017046:Cost Savings; D003362:Cost-Benefit Analysis / Q000191:economics; D003422:Critical Care / Q000191:economics*; D016638:Critical Illness / Q000191:economics; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000191:economics*; D013557:Switzerland; D013997:Time Factors
Cost-effectiveness; Energy requirements; Infections; Intensive care unit; Pharmacoeconomics; Supplemental parenteral nutrition