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. 2013 Aug 23:5:429-36.
doi: 10.2147/CEOR.S50722. eCollection 2013.

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

Gordon S Doig  1 , Hélène Chevrou-Séverac, Fiona Simpson
Affiliations

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

Gordon S Doig et al. Clinicoecon Outcomes Res. .

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.

Keywords: cost-effectiveness analysis; costs; critical care; enteral feeding; intensive care; meta-analysis; nutritional support.

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Figures

Figure 1
Figure 1
Meta-analysis of ICU length of stay: early enteral nutrition vs standard care. Notes: Heterogeneity: χ2 = 2.94, df = 3 (P = 0.40); I2 = 0%. Test for overall effect Z = 1.87 (P = 0.06). Abbreviations: CI, confidence interval; EEN, early enteral nutrition; ICU, Intensive Care Unit; IV, inverse variance; SD, standard deviation; SoC, standard of care.
Figure 2
Figure 2
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.
Figure 3
Figure 3
Meta-analysis of hospital length of stay: early enteral nutrition versus standard care. Notes: Heterogeneity: χ2 = 1.69, df = 1 (P = 0.41); I2 = 0%. Test for overall effect: Z = 0.40 (P = 0.72). Abbreviations: CI, confidence interval; EEN, early enteral nutrition; IV, inverse variance; SD, standard deviation; SoC, standard of care.
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References

    1. Martin CM, Doig GS, Heyland DK, Morrison T, Sibbald WJ, Southwestern Ontario Critical Care Research Network Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT) CMAJ. 2004;170(2):197–204. - PMC - PubMed
    1. McClave SA, Martindale RG, Vanek VW, et al. ASPEN Board of Directors. American College of Critical Care Medicine. Society of Critical Care Medicine Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) JPEN J Parenter Enteral Nutr. 2009;33(3):277–316. - PubMed
    1. Kreymann KG, Berger MM, Deutz NE, et al. DGEM (German Society for Nutritional Medicine) ESPEN (European Society for Parenteral and Enteral Nutrition) ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006;25(2):210–223. - PubMed
    1. Doig GS, Simpson F.Evidence-Based Guidelines for Nutritional Support of the Critically Ill: Results of a Bi-National Guideline Development Conference Sydney: EvidenceBased.net; 2005
    1. Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P, Canadian Critical Care Clinical Practice Guidelines Committee Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003;27(5):355–373. - PubMed