Castillo Rabaneda R M, Gómez Candela C, de Cos Blanco A I, González Fernández B, Iglesias Rosado C
Unidad de Nutrición Clínica y Dietética, Hospital Universitario La Paz, Madrid, España.
Nutr Hosp. 1998 Nov-Dec;13(6):320-4.
When home enteral nutrition is needed, there is still, despite the undisputed increase in the quality of life that can be achieved with a Percutaneous Endoscopic Gastrostomy (PEG), a reservation in its use because this technique and its maintenance is considered to be very costly. We aim to assess the true cost of home enteral nutrition using the oral route, a nasogastric tube, and PEG.
The data of 65 patients who required home enteral nutrition during 1996, were analyzed retrospectively. The access route was a nasogastric tube in 20 cases, 18 patients had PEG, and 27 candidates used an oral route. The average age was 56 years. 50% were men and 50% were women. The most common diagnoses that led to the indication were oropharyngeal-maxillofacial neoplasms and neurological disorders. In all cases the material and formula used was assessed, as were the associated complications and the cost of the at home enteral nutrition.
The average duration of the treatment was 175 +/- 128 days, and this was similar in all three groups. The average formula/day cost was slightly higher in the patients using the oral access route. The average total day cost and the average material/day cost was slightly higher in patients with a PEG. Patients with a PEG presented fewer complications than those with a nasogastric tube. The cost derived from possible complications must be higher in the nasogastric tube group, especially considering the repeated tube changes due to obstruction or loss.
The cost of home enteral nutrition is slightly lower if one uses a nasogastric tube. The greater incidence of complications that were mild but required a tube change, in this case a nasogastric tube, suggests higher indirect costs. The oral route is associated with the need for special formulae that are more expensive.
当需要家庭肠内营养时，尽管经皮内镜下胃造口术（PEG）能够显著提高生活质量，但由于该技术及其维护成本高昂，其使用仍存在一定顾虑。我们旨在评估经口途径、鼻胃管和PEG进行家庭肠内营养的实际成本。
回顾性分析了1996年期间65例需要家庭肠内营养的患者的数据。其中20例采用鼻胃管途径，18例采用PEG，27例患者采用经口途径。平均年龄为56岁，男女各占50%。导致需要进行家庭肠内营养的最常见诊断为口咽颌面肿瘤和神经系统疾病。在所有病例中，均评估了所使用的材料和配方、相关并发症以及家庭肠内营养的成本。
治疗的平均持续时间为175±128天，三组相似。经口途径患者的平均每日配方成本略高。PEG患者的平均每日总成本和平均每日材料成本略高。PEG患者的并发症少于鼻胃管患者。鼻胃管组因可能的并发症产生的成本肯定更高，尤其是考虑到因堵塞或丢失而需要反复更换鼻胃管。
使用鼻胃管进行家庭肠内营养的成本略低。鼻胃管组并发症发生率较高，虽症状较轻但需要更换鼻胃管，这表明间接成本较高。经口途径需要使用更昂贵的特殊配方。
