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Crit Care. 2018 Jan 15;22(1):4. doi: 10.1186/s13054-017-1936-2.

Cost-effectiveness study of early versus late parenteral nutrition in critically ill children (PEPaNIC): preplanned secondary analysis of a multicentre randomised controlled trial.

Author information

1
Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
2
Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.
3
Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, University Hospitals Leuven, Leuven, Belgium.
4
Department of Control and Compliance, Erasmus Medical Centre, Rotterdam, The Netherlands.
5
Department Medical Administration, University Hospitals Leuven, Leuven, Belgium.
6
Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, University Hospitals Leuven, Leuven, Belgium. greet.vandenberghe@kuleuven.be.

Abstract

BACKGROUND:

The multicentre randomised controlled PEPaNIC trial showed that withholding parenteral nutrition (PN) during the first week of critical illness in children was clinically superior to providing early PN. This study describes the cost-effectiveness of this new nutritional strategy.

METHODS:

Direct medical costs were calculated with use of a micro-costing approach. We compared the costs of late versus early initiation of PN (n = 673 versus n = 670 patients) in the Belgian and Dutch study populations from a hospital perspective, using Student's t test with bootstrapping. Main cost drivers were identified and the impact of new infections on the total costs was assessed.

RESULTS:

Mean direct medical costs for patients receiving late PN (€26.680, IQR €10.090-28.830 per patient) were 21% lower (-€7.180, p = 0.007) than for patients receiving early PN (€33.860, IQR €11.080-34.720). Since late PN was more effective and less costly, this strategy was superior to early PN. The lower costs for PN only contributed 2.1% to the total cost reduction. The main cost driver was intensive care hospitalisation costs (-€4.120, p = 0.003). The patients who acquired a new infection (14%) were responsible for 41% of the total costs. Sensitivity analyses confirmed consistency across both healthcare systems.

CONCLUSIONS:

Late initiation of PN decreased the direct medical costs for hospitalisation in critically ill children, beyond the expected lower costs for withholding PN. Avoiding new infections by late initiation of PN yielded a large cost reduction. Hence, late initiation of PN was superior to early initiation of PN largely via its effect on new infections.

TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01536275 . Registered on 16 February 2012.

KEYWORDS:

Cost-effectiveness; Costs; Health economics; Intensive care; Parenteral nutrition

PMID:
29335014
PMCID:
PMC5769527
DOI:
10.1186/s13054-017-1936-2
[Indexed for MEDLINE]
Free PMC Article

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