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Title: Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial
Authors: Vanderheyden, Simon ×
Casaer, Michaƫl
Kesteloot, Katrien
Simoens, Steven
De Rijdt, Thomas
Peers, Guido
Wouters, Pieter
Coenegrachts, Jocelijn
Grieten, Tine
Polders, Katleen
Maes, Ann
Wilmer, Alexander
Dubois, Jasperina
Van den Berghe, Greet
Mesotten, Dieter #
Issue Date: May-2012
Publisher: Current Science Ltd.
Series Title: Critical Care vol:16 issue:3
Article number: R96
Abstract: ABSTRACT: INTRODUCTION: The EPaNIC randomized controlled multicentre trial showed that postponing initiation of parenteral nutrition (PN) in ICU-patients to beyond the first week (Late-PN) enhanced recovery, as compared with Early-PN. This was mediated by fewer infections, accelerated recovery from organ failure and reduced duration of hospitalization. Now, the trial's preplanned cost analysis (N = 4640) from the Belgian healthcare payers' perspective is reported. METHODS: Cost data were retrieved from individual patient invoices. Undiscounted total healthcare costs were calculated for the index hospital stay. A cost tree based on acquisition of new infections and on prolonged length-of-stay was constructed. Contribution of 8 cost categories to total hospitalization costs was analyzed. The origin of drug costs was clarified in detail through the Anatomical Therapeutic Chemical (ATC) classification system. The potential impact of Early-PN on total hospitalization costs in other healthcare systems was explored in a sensitivity analysis. RESULTS: ICU-patients developing new infection (24.4%) were responsible for 42.7% of total costs, while ICU-patients staying beyond one week (24.3%) accounted for 43.3% of total costs. Pharmacy-related costs represented 30% of total hospitalization costs and were increased by Early-PN (+608.00 EUR/patient, p = 0.01). Notably, costs for ATC-J (anti-infective agents) (+227.00 EUR/patient, p = 0.02) and ATC-B (comprising PN) (+220.00 EUR/patient, p = 0.006) drugs were increased by Early-PN. Sensitivity analysis revealed a mean total cost increase of 1,210.00 EUR/patient (p = 0.02) by Early-PN, when incorporating the full PN costs. CONCLUSIONS: The increased costs by Early-PN were mainly pharmacy-related and explained by higher expenditures for PN and anti-infective agents. The use of Early-PN in critically ill patients can thus not be recommended for both clinical (no benefit) and cost-related reasons. TRIAL REGISTRATION: ClinicalTrials.gov NCT00512122.
ISSN: 1466-609X
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Laboratory of Intensive Care Medicine
Laboratory for Clinical Infectious and Inflammatory Disorders
Faculty of Pharmaceutical Sciences - miscellaneous
Department of Cellular and Molecular Medicine - miscellaneous
Department of Public Health miscellaneous
Research Centre for Pharmaceutical Care and Pharmaco-economics (-)
× corresponding author
# (joint) last author

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