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Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial

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 fail...

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Autores principales: Vanderheyden, Simon, Casaer, Michael P, Kesteloot, Katrien, Simoens, Steven, De Rijdt, Thomas, Peers, Guido, Wouters, Pieter J, Coenegrachts, Jocelijn, Grieten, Tine, Polders, Katleen, Maes, Ann, Wilmer, Alexander, Dubois, Jasperina, Van den Berghe, Greet, Mesotten, Dieter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580642/
https://www.ncbi.nlm.nih.gov/pubmed/22632574
http://dx.doi.org/10.1186/cc11361
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author Vanderheyden, Simon
Casaer, Michael P
Kesteloot, Katrien
Simoens, Steven
De Rijdt, Thomas
Peers, Guido
Wouters, Pieter J
Coenegrachts, Jocelijn
Grieten, Tine
Polders, Katleen
Maes, Ann
Wilmer, Alexander
Dubois, Jasperina
Van den Berghe, Greet
Mesotten, Dieter
author_facet Vanderheyden, Simon
Casaer, Michael P
Kesteloot, Katrien
Simoens, Steven
De Rijdt, Thomas
Peers, Guido
Wouters, Pieter J
Coenegrachts, Jocelijn
Grieten, Tine
Polders, Katleen
Maes, Ann
Wilmer, Alexander
Dubois, Jasperina
Van den Berghe, Greet
Mesotten, Dieter
author_sort Vanderheyden, Simon
collection PubMed
description 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.
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spelling pubmed-35806422013-02-26 Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial Vanderheyden, Simon Casaer, Michael P Kesteloot, Katrien Simoens, Steven De Rijdt, Thomas Peers, Guido Wouters, Pieter J Coenegrachts, Jocelijn Grieten, Tine Polders, Katleen Maes, Ann Wilmer, Alexander Dubois, Jasperina Van den Berghe, Greet Mesotten, Dieter Crit Care Research 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. BioMed Central 2012 2012-05-25 /pmc/articles/PMC3580642/ /pubmed/22632574 http://dx.doi.org/10.1186/cc11361 Text en Copyright ©2012 Vanderheyden et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Vanderheyden, Simon
Casaer, Michael P
Kesteloot, Katrien
Simoens, Steven
De Rijdt, Thomas
Peers, Guido
Wouters, Pieter J
Coenegrachts, Jocelijn
Grieten, Tine
Polders, Katleen
Maes, Ann
Wilmer, Alexander
Dubois, Jasperina
Van den Berghe, Greet
Mesotten, Dieter
Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial
title Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial
title_full Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial
title_fullStr Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial
title_full_unstemmed Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial
title_short Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial
title_sort early versus late parenteral nutrition in icu patients: cost analysis of the epanic trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580642/
https://www.ncbi.nlm.nih.gov/pubmed/22632574
http://dx.doi.org/10.1186/cc11361
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