Parenteral nutrition including an omega-3 fatty-acid-containing lipid emulsion for intensive care patients in China: a pharmacoeconomic analysis

Abstract

Background/objectives: Parenteral nutrition (PN) incorporating omega-3 fatty-acid-enriched lipid emulsions has been shown to be cost effective in Western populations. A pharmacoeconomic evaluation was performed within the Chinese intensive care unit (ICU) setting. This assessed whether the additional acquisition cost of PN with omega-3 fatty-acid-enriched lipid emulsion (SMOFlipid) vs standard PN was offset by improved clinical outcomes that can reduce subsequent costs.

Materials and methods: A pharmacoeconomic discrete event simulation model was developed, based on an update to efficacy data from a previous international meta-analysis, with China-specific clinical and economic input parameters. Sensitivity analyses were undertaken to assess the effects of uncertainty around input parameters.

Results: The model predicted that PN with an omega-3 fatty-acid-enriched lipid emulsion was more effective and less costly than PN with standard lipid emulsions for Chinese ICU patients, as follows: reduced length of overall hospital length of stay (19.48 vs 21.35 days, respectively), reduced length of ICU stay (5.03 vs 6.18 days, respectively), and prevention of 35.6% of nosocomial infections leading to a lower total cost per patient (¥47 189 [US $6937] vs ¥54 783 [US $8053], respectively). Additional treatment costs were offset by savings in overall hospital and ICU stay cost, and antibiotic cost, resulting in a mean cost saving of ¥7594 (US $1116) per patient. Sensitivity analyses confirmed the robustness of these findings.

Conclusions: PN enriched with an omega-3 fatty-acid-containing lipid emulsion vs standard PN may be effective in reducing length of hospital and ICU stay and infectious complications in Chinese ICU patients, and also decreases overall treatment costs. This results in a favorable cost-effectiveness ratio. Thus, PN enriched with an omega-3 fatty-acid-containing lipid emulsion can be seen as a win-win situation for patients, hospital administration, and health insurance companies.

Keywords: China; cost effectiveness; intensive care; lipid emulsion; omega-3; parenteral nutrition.

Figure 1

Model structure of transition probabilities. Notes: Data from Du et al. Abbreviation: ICU, intensive care unit.

Figure 2

Infections: random effects meta-analysis and Forest plot for parenteral nutrition including omega-3 fatty-acid-enriched lipid emulsion vs standard parenteral nutrition not containing omega-3 fatty acids. Notes: Squares represent individual study means of the effect measure; the pooled estimate is represented by a diamond symbol.

Figure 3

Length of intensive care unit stay: random effects meta-analysis and Forest plot for parenteral nutrition including omega-3 fatty-acid-enriched lipid emulsion vs standard parenteral nutrition not containing omega-3 fatty acids. Notes: Squares represent individual study means of the effect measure; the pooled estimate is represented by a diamond symbol.

Figure 4

Post-intensive care unit length of hospital stay: random effects meta-analysis and Forest plot for parenteral nutrition including omega-3 fatty-acid-enriched lipid emulsion vs standard parenteral nutrition not containing omega-3 fatty acids. Notes: Squares represent individual study means of the effect measure; the pooled estimate is represented by a diamond symbol.

Figure 5

Scatterplot of the results of the probabilistic sensitivity analysis for parenteral nutrition including omega-3 fatty-acid-enriched lipid emulsions vs standard parenteral nutrition not containing omega-3 fatty acids. Abbreviation: PSA, probabilistic sensitivity analysis.

Figure 6

Tornado plot of deterministic sensitivity analysis results on the difference in total cost (¥) between standard parenteral nutrition not containing omega-3 fatty acids minus parenteral nutrition with omega-3 fatty-acid-enriched lipid emulsions. Abbreviations: ICU, intensive care unit; LOS, length of stay.