The economic costs of home parenteral nutrition: Systematic review of partial and full economic evaluations

Abstract

Background & aims: Home parenteral nutrition (HPN) is indicated in patients with chronic intestinal failure. The aim of the current study was to review existing scientific literature of full or partial economic evaluations associated to HPN.

Methods: A bibliographic database search was undertaken in PubMed (MEDLINE), Embase and Scopus, complemented by a reference list search. We combined search terms regarding HPN and costs/health economics. The inclusion criteria included: a) population: all population and age groups; b) intervention: partial or full HPN; c) comparator: no parenteral nutrition, continued or intermittent hospital based PN, other nutritional interventions or no comparator; d) outcomes: cost outcomes and economic evaluations associated to HPN. A different quality assessment tool was used for each of the different type of economic approach.

Results: Twenty-three papers were included in the final review. 21 were partial economic evaluations (16 cost-of-illness studies and 5 cost analyses), and 2 were full economic evaluations, both cost-utility analysis. Most studies investigated costs from a healthcare perspective (n = 18), therefore they included only direct costs. Three studies included personal costs for HPN patient. None of the studies included productivity costs.

Conclusions: Most scientific literature regarding the economic costs of HPN comes from partial economic evaluations, such as cost-of-illness studies and cost analysis. According to them, HPN is an expensive treatment, although cost saving when compared to hospital based parenteral nutrition (PN). Full economic evaluations proved HPN as being cost-effective than hospital based PN, however more research is needed to confirm this in all settings.

Keywords: Cost analysis; Cost of illness; Economic evaluation; Home parenteral nutrition.