Puntis J W
University of Leeds, Children's Centre, General Infirmary at Leeds, UK.
Nutrition. 1998 Oct;14(10):809-12. doi: 10.1016/s0899-9007(98)00090-2.
During the past 30 y long-term parenteral nutrition has evolved from a novel technique to a well-established intervention for gastrointestinal failure. The development of home care has been driven by technological advances and patient/family choice as well as financial constraints, reflecting a shift in resources from hospital to community. Annual costs for adult home parenteral nutrition have recently been estimated to range from US $150,000-250,000 in the USA, and are around 55,000 Pounds in the UK, perhaps only 25-50% of in-hospital costs. In the absence of any alternative treatment for children with gastrointestinal failure, parenteral nutrition is life saving, and when performed at home offers the prospect of maintaining a good quality of life. Cost-utility appraisals of home parenteral nutrition in adults incorporating quality of life assessment have shown the cost of one quality adjusted life year to be around 69,000 Pounds in the UK (1995), and Can $14,600 in Canada (1984), making home parenteral nutrition relatively cost-effective compared with other ways of spending money to improve health. Because there are no published economic appraisals of pediatric home parenteral nutrition, this paper is based on a review of the literature relating to adult patients.
在过去30年里，长期肠外营养已从一项新技术发展成为针对胃肠功能衰竭的成熟干预措施。家庭护理的发展受到技术进步、患者/家庭选择以及经济限制的推动，这反映了资源从医院向社区的转移。最近估计，美国成人家庭肠外营养的年度费用在15万至25万美元之间，英国约为5.5万英镑，可能仅为住院费用的25%至50%。对于胃肠功能衰竭的儿童，在没有任何替代治疗方法的情况下，肠外营养可以挽救生命，而且在家中进行肠外营养有望维持良好的生活质量。纳入生活质量评估的成人家庭肠外营养成本效用评估显示，在英国（1995年），一个质量调整生命年的成本约为6.9万英镑，在加拿大（1984年）为1.46万加元，与其他改善健康的花钱方式相比，家庭肠外营养相对具有成本效益。由于目前尚无关于儿科家庭肠外营养的公开经济评估，本文基于对与成年患者相关文献的综述。
