Executive Insight AG, 8008 Zurich, Switzerland.
Maverex Ltd., Newcastle upon Tyne NE6 2HL, UK.
Nutrients. 2020 Aug 20;12(9):2531. doi: 10.3390/nu12092531.
The safety of parenteral nutrition (PN) remains a concern in preterm neonates, impacting clinical outcomes and health-care-resource use and costs. This cost-consequence analysis assessed national-level impacts of a 10-percentage point increase in use of industry-prepared three-chamber bags (3CBs) on clinical outcomes, healthcare resources, and hospital budgets across seven European countries. A ten-percentage-point 3CB use-increase model was developed for Belgium, France, Germany, Italy, Portugal, Spain, and the UK. The cost-consequence analysis estimated the impact on compounding error harm and bloodstream infection (BSI) rates, staff time, and annual hospital budget. Of 265,000 (52%) preterm neonates, 133,000 (52%) were estimated to require PN. Baseline compounding methods were estimated as 43% pharmacy manual, 16% pharmacy automated, 22% ward, 9% outsourced, 3% industry provided non-3CBs, and 7% 3CBs. A modeled increased 3CB use would change these values to 39%, 15%, 18%, 9%, 3%, and 17%, respectively. Modeled consequences included -11.6% for harm due to compounding errors and -2.7% for BSIs. Labor time saved would equate to 41 specialized nurses, 29 senior pharmacists, 26 pharmacy assistants, and 22 senior pediatricians working full time. Budget impact would be a €8,960,601 (3.4%) fall from €260,329,814 to €251,369,212. Even a small increase in the use of 3CBs in preterm neonates could substantially improve neonatal clinical outcomes, and provide notable resource and cost savings to hospitals.
肠外营养（PN）的安全性仍然是早产儿关注的问题，会影响临床结果以及医疗保健资源的使用和成本。这项成本-后果分析评估了在七个欧洲国家，使用工业预配三室袋（3CB）的比例提高 10 个百分点对临床结果、医疗资源和医院预算的国家层面影响。为比利时、法国、德国、意大利、葡萄牙、西班牙和英国制定了一个使用 3CB 增加 10 个百分点的模型。成本-后果分析估计了对配制错误伤害和血流感染（BSI）率、员工时间和年度医院预算的影响。在 265000 名（52%）早产儿中，估计有 133000 名（52%）需要 PN。基线配制方法估计为 43%的药房手动、16%的药房自动、22%的病房、9%的外包、3%的工业提供非 3CB 袋和 7%的 3CB 袋。模拟增加 3CB 的使用将分别将这些值改变为 39%、15%、18%、9%、3%和 17%。模拟的后果包括配制错误造成的伤害减少 11.6%和 BSI 减少 2.7%。节省的劳动力相当于 41 名专科护士、29 名高级药剂师、26 名药剂助理和 22 名高级儿科医生全职工作。预算影响将从 260329814 欧元降至 251369212 欧元，下降 8960601 欧元（3.4%）。即使在早产儿中使用 3CB 的比例略有增加，也可能显著改善新生儿的临床结果，并为医院提供显著的资源和成本节约。
