AdRes-Health Economics and Outcome Research, Via Vittorio Alfieri 17, 10121, Turin, Italy.
Department of General and Oncology Surgery With Intestinal Failure Unit, Stanley Dudrick's Memorial Hospital, Tyniecka 15, 32-050, Skawina, Poland.
Crit Care. 2020 Nov 3;24(1):634. doi: 10.1186/s13054-020-03356-w.
Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions. Here, we evaluate the impact of ω-3 FA-containing PN versus standard PN on clinical outcomes and costs in adult intensive care unit (ICU) patients using a meta-analysis and subsequent cost-effectiveness analysis from the perspective of a hospital operating in five European countries (France, Germany, Italy, Spain, UK) and the US.
We present a pharmacoeconomic simulation based on a systematic literature review with meta-analysis. Clinical outcomes and costs comparing ω-3 FA-containing PN with standard PN were evaluated in adult ICU patients eligible to receive PN covering at least 70% of their total energy requirements and in the subgroup of critically ill ICU patients (mean ICU stay > 48 h). The meta-analysis with the co-primary outcomes of infection rate and mortality rate was based on randomized controlled trial data retrieved via a systematic literature review; resulting efficacy data were subsequently employed in country-specific cost-effectiveness analyses.
In adult ICU patients, ω-3 FA-containing PN versus standard PN was associated with significant reductions in the relative risk (RR) of infection (RR 0.62; 95% CI 0.45, 0.86; p = 0.004), hospital length of stay (HLOS) (- 3.05 days; 95% CI - 5.03, - 1.07; p = 0.003) and ICU length of stay (LOS) (- 1.89 days; 95% CI - 3.33, - 0.45; p = 0.01). In critically ill ICU patients, ω-3 FA-containing PN was associated with similar reductions in infection rates (RR 0.65; 95% CI 0.46, 0.94; p = 0.02), HLOS (- 3.98 days; 95% CI - 6.90, - 1.06; p = 0.008) and ICU LOS (- 2.14 days; 95% CI - 3.89, - 0.40; p = 0.02). Overall hospital episode costs were reduced in all six countries using ω-3 FA-containing PN compared to standard PN, ranging from €-3156 ± 1404 in Spain to €-9586 ± 4157 in the US.
These analyses demonstrate that ω-3 FA-containing PN is associated with statistically and clinically significant improvement in patient outcomes. Its use is also predicted to yield cost savings compared to standard PN, rendering ω-3 FA-containing PN an attractive cost-saving alternative across different health care systems.
PROSPERO CRD42019129311.
与不含ω-3 脂肪酸脂质乳剂的标准肠外营养（PN）方案相比，含ω-3 脂肪酸的 PN 可显著改善患者的结局。在此，我们通过荟萃分析和随后的成本效益分析，从五个欧洲国家（法国、德国、意大利、西班牙、英国）和美国的一家医院的角度，评估含ω-3 脂肪酸的 PN 与标准 PN 对成人重症监护病房（ICU）患者临床结局和成本的影响。
我们根据系统文献回顾和荟萃分析提出了一种药物经济学模拟。在有资格接受至少满足其总能量需求 70%的 PN 治疗的成年 ICU 患者和危重症 ICU 患者亚组（平均 ICU 入住时间＞48 小时）中，比较了含ω-3 脂肪酸的 PN 与标准 PN。基于系统文献检索获得的随机对照试验数据，进行了荟萃分析，其主要终点为感染率和死亡率；随后，将相应的疗效数据应用于各国的成本效益分析。
在成年 ICU 患者中，与标准 PN 相比，含ω-3 脂肪酸的 PN 与感染率的相对风险（RR）显著降低（RR 0.62；95% CI 0.45，0.86；p=0.004），住院时间（HLOS）减少（-3.05 天；95% CI -5.03，-1.07；p=0.003），以及 ICU 入住时间（LOS）减少（-1.89 天；95% CI -3.33，-0.45；p=0.01）。在危重症 ICU 患者中，含ω-3 脂肪酸的 PN 与感染率（RR 0.65；95% CI 0.46，0.94；p=0.02）、HLOS（-3.98 天；95% CI -6.90，-1.06；p=0.008）和 ICU LOS（-2.14 天；95% CI -3.89，-0.40；p=0.02）的降低也具有相似的统计学意义。与标准 PN 相比，在所有六个国家中使用含ω-3 脂肪酸的 PN 都降低了总体医院发病成本，从西班牙的€-3156±1404 到美国的€-9586±4157。
这些分析表明，含ω-3 脂肪酸的 PN 可显著改善患者的结局，具有统计学意义和临床意义。与标准 PN 相比，它的使用还预计会带来成本节约，使含ω-3 脂肪酸的 PN 成为不同医疗保健系统中具有吸引力的节约成本的替代方案。
PROSPERO CRD42019129311。
