Feng Yufei, Li Chao, Zhang Tian, Pradelli Lorenzo
Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China.
AdRes Health Economics and Outcomes Research, Piazza Carlo Emanuele II, Torino, Italy.
Clinicoecon Outcomes Res. 2017 Sep 5;9:547-555. doi: 10.2147/CEOR.S139902. eCollection 2017.
BACKGROUND/OBJECTIVES: Parenteral nutrition (PN) incorporating omega-3 fatty-acid-enriched lipid emulsions has been shown to be cost effective in Western populations. A pharmacoeconomic evaluation was performed within the Chinese intensive care unit (ICU) setting. This assessed whether the additional acquisition cost of PN with omega-3 fatty-acid-enriched lipid emulsion (SMOFlipid) vs standard PN was offset by improved clinical outcomes that can reduce subsequent costs.
A pharmacoeconomic discrete event simulation model was developed, based on an update to efficacy data from a previous international meta-analysis, with China-specific clinical and economic input parameters. Sensitivity analyses were undertaken to assess the effects of uncertainty around input parameters.
The model predicted that PN with an omega-3 fatty-acid-enriched lipid emulsion was more effective and less costly than PN with standard lipid emulsions for Chinese ICU patients, as follows: reduced length of overall hospital length of stay (19.48 vs 21.35 days, respectively), reduced length of ICU stay (5.03 vs 6.18 days, respectively), and prevention of 35.6% of nosocomial infections leading to a lower total cost per patient (¥47 189 [US $6937] vs ¥54 783 [US $8053], respectively). Additional treatment costs were offset by savings in overall hospital and ICU stay cost, and antibiotic cost, resulting in a mean cost saving of ¥7594 (US $1116) per patient. Sensitivity analyses confirmed the robustness of these findings.
PN enriched with an omega-3 fatty-acid-containing lipid emulsion vs standard PN may be effective in reducing length of hospital and ICU stay and infectious complications in Chinese ICU patients, and also decreases overall treatment costs. This results in a favorable cost-effectiveness ratio. Thus, PN enriched with an omega-3 fatty-acid-containing lipid emulsion can be seen as a win-win situation for patients, hospital administration, and health insurance companies.
背景/目的：在西方人群中，含ω-3脂肪酸强化脂质乳剂的肠外营养（PN）已被证明具有成本效益。在中国重症监护病房（ICU）环境中进行了药物经济学评估。该评估旨在确定含ω-3脂肪酸强化脂质乳剂（SMOFlipid）的PN相较于标准PN的额外购置成本，是否会因改善临床结局从而降低后续成本而得到抵消。
基于之前一项国际荟萃分析的疗效数据更新，结合中国特定的临床和经济输入参数，开发了一个药物经济学离散事件模拟模型。进行敏感性分析以评估输入参数不确定性的影响。
该模型预测，对于中国ICU患者，含ω-3脂肪酸强化脂质乳剂的PN比含标准脂质乳剂的PN更有效且成本更低，具体如下：总体住院时间缩短（分别为19.48天和21.35天），ICU住院时间缩短（分别为5.03天和6.18天），并预防35.6%的医院感染，使每位患者的总成本降低（分别为47189元人民币[6937美元]和54783元人民币[8053美元]）。额外的治疗成本被总体住院和ICU住院成本以及抗生素成本的节省所抵消，每位患者平均节省成本7594元人民币（1116美元）。敏感性分析证实了这些结果的稳健性。
含ω-3脂肪酸脂质乳剂的PN与标准PN相比，可能有效缩短中国ICU患者的住院和ICU住院时间以及减少感染并发症，还能降低总体治疗成本。这产生了有利的成本效益比。因此，含ω-3脂肪酸脂质乳剂的PN对患者、医院管理部门和医疗保险机构而言是一种双赢局面。
