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Early enteral nutrition in critical illness: a full economic analysis using US costs.

Doig GS, Chevrou-Séverac H, Simpson F - Clinicoecon Outcomes Res (2013)

Bottom Line: THE PROVISION OF EARLY EN TO CRITICALLY ILL PATIENTS IS A DOMINANT TECHNOLOGY: Patient survival is significantly improved and total costs of care reduced meaningfully.Under conservative assumptions, the total costs of acute hospital care were reduced by US$14,462 per patient (95% confidence interval US$5,464 to US$23,669).These results were robust, with all sensitivity analyses demonstrating significant savings attributable to the use of early EN, including sensitivity analysis conducted using European cost data.

View Article: PubMed Central - PubMed

Affiliation: Northern Clinical School Intensive Care Research Unit, University of Sydney, Sydney, NSW, Australia.

ABSTRACT

Purpose: Although published meta-analyses demonstrate patient survival may be improved if enteral nutrition (EN) is provided to critically ill patients within 24 hours of injury or admission to the intensive care unit (ICU), these publications did not investigate the impact of early EN on measures of health care resource consumption and total costs.

Materials and methods: From the perspective of the US acute care hospital system, a cost-effectiveness analysis was undertaken based on a large-scale Monte Carlo simulation (N = 1,000,000 trials) of a 1,000-patient stochastic model, developed using clinical outcomes and measures of resource consumption reported by published meta-analyses combined with cost distributions obtained from the published literature. The mean cost differences between early EN and standard care, along with respective 95% confidence intervals, were obtained using the percentile method.

Results and conclusion: THE PROVISION OF EARLY EN TO CRITICALLY ILL PATIENTS IS A DOMINANT TECHNOLOGY: Patient survival is significantly improved and total costs of care reduced meaningfully. Under conservative assumptions, the total costs of acute hospital care were reduced by US$14,462 per patient (95% confidence interval US$5,464 to US$23,669). These results were robust, with all sensitivity analyses demonstrating significant savings attributable to the use of early EN, including sensitivity analysis conducted using European cost data.

No MeSH data available.


Related in: MedlinePlus

Meta-analysis of duration of mechanical ventilation: early enteral nutrition vs standard care.Notes: Heterogeneity: χ2 = 1.69, df = 2 (P = 0.43); I2 = 0%. Test for overall effect Z = 1.91 (P = 0.06).Abbreviations: CI, confidence interval; EEN, early enteral nutrition; IV, inverse variance; SD, standard deviation; SoC, standard of care.
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f2-ceor-5-429: Meta-analysis of duration of mechanical ventilation: early enteral nutrition vs standard care.Notes: Heterogeneity: χ2 = 1.69, df = 2 (P = 0.43); I2 = 0%. Test for overall effect Z = 1.91 (P = 0.06).Abbreviations: CI, confidence interval; EEN, early enteral nutrition; IV, inverse variance; SD, standard deviation; SoC, standard of care.

Mentions: Patients receiving early EN demonstrated a strong trend towards a reduction in duration of ICU stay (−2.3 days [95% CI −4.8 to 0.1 days, P = 0.06, I2 = 0%]) (Figure 1) and duration of mechanical ventilation (−2.5 days [95% CI −5.1 to 0.1 days, P = 0.06, I2 = 0%]) (Figure 2); however, the hospital length of stay did not differ between the groups (−2.5 days [95% CI −16.0 to 11.0 days, P = 0.72, I2 = 0%]) (Figure 3).


Early enteral nutrition in critical illness: a full economic analysis using US costs.

Doig GS, Chevrou-Séverac H, Simpson F - Clinicoecon Outcomes Res (2013)

Meta-analysis of duration of mechanical ventilation: early enteral nutrition vs standard care.Notes: Heterogeneity: χ2 = 1.69, df = 2 (P = 0.43); I2 = 0%. Test for overall effect Z = 1.91 (P = 0.06).Abbreviations: CI, confidence interval; EEN, early enteral nutrition; IV, inverse variance; SD, standard deviation; SoC, standard of care.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3755543&req=5

f2-ceor-5-429: Meta-analysis of duration of mechanical ventilation: early enteral nutrition vs standard care.Notes: Heterogeneity: χ2 = 1.69, df = 2 (P = 0.43); I2 = 0%. Test for overall effect Z = 1.91 (P = 0.06).Abbreviations: CI, confidence interval; EEN, early enteral nutrition; IV, inverse variance; SD, standard deviation; SoC, standard of care.
Mentions: Patients receiving early EN demonstrated a strong trend towards a reduction in duration of ICU stay (−2.3 days [95% CI −4.8 to 0.1 days, P = 0.06, I2 = 0%]) (Figure 1) and duration of mechanical ventilation (−2.5 days [95% CI −5.1 to 0.1 days, P = 0.06, I2 = 0%]) (Figure 2); however, the hospital length of stay did not differ between the groups (−2.5 days [95% CI −16.0 to 11.0 days, P = 0.72, I2 = 0%]) (Figure 3).

Bottom Line: THE PROVISION OF EARLY EN TO CRITICALLY ILL PATIENTS IS A DOMINANT TECHNOLOGY: Patient survival is significantly improved and total costs of care reduced meaningfully.Under conservative assumptions, the total costs of acute hospital care were reduced by US$14,462 per patient (95% confidence interval US$5,464 to US$23,669).These results were robust, with all sensitivity analyses demonstrating significant savings attributable to the use of early EN, including sensitivity analysis conducted using European cost data.

View Article: PubMed Central - PubMed

Affiliation: Northern Clinical School Intensive Care Research Unit, University of Sydney, Sydney, NSW, Australia.

ABSTRACT

Purpose: Although published meta-analyses demonstrate patient survival may be improved if enteral nutrition (EN) is provided to critically ill patients within 24 hours of injury or admission to the intensive care unit (ICU), these publications did not investigate the impact of early EN on measures of health care resource consumption and total costs.

Materials and methods: From the perspective of the US acute care hospital system, a cost-effectiveness analysis was undertaken based on a large-scale Monte Carlo simulation (N = 1,000,000 trials) of a 1,000-patient stochastic model, developed using clinical outcomes and measures of resource consumption reported by published meta-analyses combined with cost distributions obtained from the published literature. The mean cost differences between early EN and standard care, along with respective 95% confidence intervals, were obtained using the percentile method.

Results and conclusion: THE PROVISION OF EARLY EN TO CRITICALLY ILL PATIENTS IS A DOMINANT TECHNOLOGY: Patient survival is significantly improved and total costs of care reduced meaningfully. Under conservative assumptions, the total costs of acute hospital care were reduced by US$14,462 per patient (95% confidence interval US$5,464 to US$23,669). These results were robust, with all sensitivity analyses demonstrating significant savings attributable to the use of early EN, including sensitivity analysis conducted using European cost data.

No MeSH data available.


Related in: MedlinePlus