Sartori S, Trevisani L, Tassinari D, Gilli G, Nielsen I, Maestri A, Abbasciano V
II Divisione Medica, Ospedale S. Anna, Ferrara, Italy.
Support Care Cancer. 1996 Jan;4(1):21-6. doi: 10.1007/BF01769870.
The aim of this study was to evaluate prospectively the cost of long-term feeding by percutaneous endoscopic gastrostomy (PEG). Cost analysis was carried out in 34 head and neck cancer patients, followed from the time of PEG placement to the death or the end of the study. Three main items were considered: (a) PEG placement (on an inpatient basis), subdivided into five subitems: the Freka FK-07 gastrostomy kit, materials and anaesthetic drugs used, antibiotics and antisecretory drugs, gastroscope amortization expenses and staff; (b) nutrition, considering the costs of enteral-feeding products, nutrition container and flexible tube connecting the container to the PEG; (c) patient care, dividing the patients into three groups: outpatients, home-care patients and outpatients shifting to home care during the follow-up. All patients had one medical and two nursing visits/month, and, if necessary, immediate additional access to a physician or nurse. The mean daily cost per patient of long-term feeding via PEG was obtained by adding up the mean daily costs per patient of the three items, and was compared with that of feeding via nasogastric tube, calculated in 11 patients using the same criteria. No procedure-related death nor periprocedural major or minor complications were observed. The 60-day mortality was 3/34. Seventeen patients were always seen on an outpatient basis and 8 were followed by our home-care unit: 9 outpatients shifted to home care during the follow-up. The mean duration of PEG use was 180.5 days (range 47-639). Two wound infections, treated with antibiotics, occurred during the follow-up. The mean daily costs of placement, nutrition and patient care were (Italian Iiras) L 2500, 24 510 and 1880 respectively (Deutschemarks: DM 2.08, 20.42 and 1.56), for a total mean daily cost of L 28,890 (DM 24.06), slightly higher than that of feeding via a nasogastric tube (L 27,340; DM 22.78). On the basis of the improved quality of life, as well as from the economic point of view, PEG can be considered the procedure of choice for enteral feeding of cancer patients, provided that a reasonably long survival can be expected.
本研究的目的是前瞻性评估经皮内镜下胃造口术（PEG）长期喂养的成本。对34例头颈癌患者进行了成本分析，从PEG置入时开始随访直至死亡或研究结束。考虑了三个主要项目：（a）PEG置入（住院情况下），细分为五个子项目：Freka FK - 07胃造口术套件、使用的材料和麻醉药物、抗生素和抗分泌药物、胃镜折旧费用及工作人员；（b）营养，考虑肠内喂养产品、营养容器以及连接容器与PEG的软管的成本；（c）患者护理，将患者分为三组：门诊患者、居家护理患者以及随访期间从门诊转为居家护理的患者。所有患者每月接受一次医疗和两次护理访视，必要时可立即额外联系医生或护士。通过将三个项目的每位患者每日平均成本相加，得出经PEG长期喂养的每位患者每日平均成本，并与11例采用相同标准计算的经鼻胃管喂养的成本进行比较。未观察到与操作相关的死亡，也未出现围手术期的严重或轻微并发症。60天死亡率为3/34。17例患者一直为门诊患者，8例由我们的居家护理单元随访：9例门诊患者在随访期间转为居家护理。PEG使用的平均持续时间为180.5天（范围47 - 639天）。随访期间发生了两例伤口感染，使用抗生素进行了治疗。置入、营养和患者护理的每日平均成本分别为（意大利里拉）2500里拉、24510里拉和1880里拉（德国马克：2.08马克、20.42马克和1.56马克），总平均每日成本为28890里拉（24.06马克），略高于经鼻胃管喂养的成本（27,340里拉；22.78马克）。基于生活质量的改善以及经济角度考虑，只要预期有合理的较长生存期，PEG可被视为癌症患者肠内喂养的首选方法。
