The online version of this article (doi:10.1186/1477-7819-10-136) contains supplementary material, which is available to authorized users.
Funding support for the preparation of this manuscript was received from NESTLÉ Healthcare Nutrition (NESTLE), the maker of IMPACT®, an immunonutrition formula. two authors are employees of RTI Health Solutions and received funding from NESTLÉ to conduct this study and prepare this manuscript (JM and SC), and two authors are employees of NESTLÉ (HC-S and JO). JO is currently taking a leave of absence from his work as professor of surgery and critical care at the University of Pittsburgh.
SC was responsible for performing the cost analyses using the NIS data and for interpretation of the results and review of the manuscript; JM was responsible for study design and interpretation of results and for preparing the manuscript; HC-S and JO contributed to study design and interpretation of the results and to the writing and review of the manuscript. All authors had full access to all of the data in the study, all take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the final manuscript.
Oral or enteral dietary supplementation with arginine, omega 3 fatty acids and nucleotides (known as immunonutrition) significantly improve outcomes in patients undergoing elective surgery. The objective of the study was to determine the impact on hospital costs of immunonutrition formulas used in patients undergoing elective surgery for gastrointestinal cancer.
US hospital costs of stay with and without surgical infectious complications, and average cost per day in the hospital for patients undergoing elective surgery for gastrointestinal cancer were estimated using data from the Healthcare Cost and Utilization Project’s 2008 Nationwide Inpatient Sample. These costs were then used to estimate the impact of perioperative immunonutrition on hospital costs using estimates of reduction in infectious complications or length of stay from a meta-analysis of clinical trials in patients undergoing elective surgery for gastrointestinal cancer. Sensitivity of the results to changes in baseline complication rates or length of stay was tested.
From the meta-analysis estimates, use of immunonutrition resulted in savings per patient of $3,300 with costs based on reduction in infectious complication rates or $6,000 with costs based on length of hospital stay. Cost savings per patient were present for baseline complication rates above 3.5% or when baseline length of stay and infectious complication rates were reduced to reflect recent US data for those with upper and lower GI elective cancer surgery (range, $1,200 to $6,300).
Use of immunonutrition for patients undergoing elective surgery for gastrointestinal cancer is an effective and cost-saving intervention.
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Healthcare Cost and Utilization Project (HCUP) Overview of the Nationwide Inpatient Sample (NIS). Agency for Healthcare Research and Quality Web site. http://www.hcup-us.ahrq.gov/nisoverview.jsp,
Senkal M, Zumtobel V, Bauer KH, Marpe B, Wolfram G, Frei A, Eickhoff U, Kemen M: Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg. 1999, 134: 1309-1316. 10.1001/archsurg.134.12.1309. CrossRefPubMed
- Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer: impact on hospital costs
Josephine A Mauskopf
Sean D Candrilli
Juan B Ochoa
- BioMed Central
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