Pradelli Lorenzo, Eandi Mario, Povero Massimiliano, Mayer Konstantin, Muscaritoli Maurizio, Heller Axel R, Fries-Schaffner Eva
AdRes HE&OR, Turin, Italy.
Pharmacology, Università degli Studi di Torino, Via Pietro Giuria 13, I-10100 Torino, Italy.
Clin Nutr. 2014 Oct;33(5):785-92. doi: 10.1016/j.clnu.2013.11.016. Epub 2013 Dec 4.
BACKGROUND & AIMS: 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.
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.
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.
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.
最近的一项荟萃分析表明，在肠外营养（PN）方案中补充ω-3脂肪酸与入住重症监护病房（ICU）的内科和外科患者以及未入住ICU的外科患者的感染率和住院时间（LOS）在统计学和临床上均显著降低有关。本研究的目的是从医疗保健提供者的角度评估在四个欧洲国家（意大利、法国、德国和英国）的标准PN方案中添加ω-3脂肪酸的成本效益。
采用离散事件模拟方案，基于意大利ICU患者群体的结果和已发表的文献，开发了一个患者水平的模拟模型。含ω-3脂肪酸的PN方案与标准PN方案的比较疗效数据取自已发表的随机临床试验的荟萃分析（n = 23项研究，共1502例患者），并对住院LOS的降低进行了进一步处理，以便将ICU住院时间的减少与入住ICU患者的院内住院时间的减少区分开来。获取了意大利、法国、德国和英国医疗保健系统的特定国家成本数据。模型中纳入的临床结果包括死亡率、医院感染率和ICU/医院LOS。进行了概率和确定性敏感性分析以检验结果的可靠性。
在所考虑的四个国家中，含ω-3脂肪酸的PN方案在ICU患者和非ICU患者中平均比标准PN方案更有效，降低了感染率和总体LOS，并导致每位患者的总成本更低。接受含ω-3脂肪酸的PN方案的患者的总成本为每位ICU患者14144欧元至19825欧元，每位非ICU患者5484欧元至14232欧元，转化为每位ICU患者节省3972欧元至4897欧元，每位非ICU患者节省561欧元至1762欧元。治疗成本完全被住院时间成本和抗生素成本的降低所抵消。敏感性分析证实了这些发现的稳健性。
这些结果表明，在意大利、法国、德国和英国的医院中，在PN方案中补充ω-3脂肪酸具有成本效益。
