TY - JOUR
T1 - An economic evaluation of perioperative enteral nutrition in patients undergoing colorectal surgery (SANICS II study)
AU - Pattamatta, Madhuri
AU - Evers, Silvia M. A. A.
AU - Smeets, Boudewijn J. J.
AU - Peters, Emmeline G.
AU - Luyer, Misha D. P.
AU - Hiligsmann, Mickael
PY - 2019
Y1 - 2019
N2 - Aims: The objective of this (trial based) economic evaluation was to assess, from a societal perspective, the cost-effectiveness of perioperative enteral nutrition compared with standard care in patients undergoing colorectal surgery. Materials and methods: Alongside the SANICS II randomized controlled trial, global quality-of-life, utilities (measured by EQ-5D-5L), healthcare costs, production losses, and patient and family costs were assessed at baseline, 3months, and 6months. Incremental cost-effectiveness ratios (ICERs) (i.e. cost per increased global quality-of-life score or quality-adjusted life year [QALY] gained) and cost effectiveness acceptability curves were visualized. Results: In total, 265 patients were included in the original trial (n=132 in the perioperative enteral nutrition group and n=133 in the standard care group). At 6months, global quality-of-life (83 vs 83, p=.357) did not differ significantly between the groups. The mean total societal costs for the intervention and standard care groups were €14,673 and €11,974, respectively, but did not reach statistical significance (p=.109). The intervention resulted in an ICER of –€6,276 per point increase in the global quality of life score. The gain in QALY was marginal (0.003), with an additional cost of €2,941, and the ICUR (Incremental cost utility ratio) was estimated at €980,333. Limitations: The cost elements for all the participating centers reflect the reference prices from the Netherlands. Patient-reported questionnaires may have resulted in recall bias. Sample size was limited by exclusion of patients who did not complete questionnaires for at least at two time points. A power analysis based on costs and health-related quality-of-life (HRQoL) was not performed. The economic impact could not be analyzed at 1month post-operatively where the effects could potentially be higher. Conclusions: This study suggests that perioperative nutrition is not beneficial for the patients in terms of quality-of-life and is not cost-effective.
AB - Aims: The objective of this (trial based) economic evaluation was to assess, from a societal perspective, the cost-effectiveness of perioperative enteral nutrition compared with standard care in patients undergoing colorectal surgery. Materials and methods: Alongside the SANICS II randomized controlled trial, global quality-of-life, utilities (measured by EQ-5D-5L), healthcare costs, production losses, and patient and family costs were assessed at baseline, 3months, and 6months. Incremental cost-effectiveness ratios (ICERs) (i.e. cost per increased global quality-of-life score or quality-adjusted life year [QALY] gained) and cost effectiveness acceptability curves were visualized. Results: In total, 265 patients were included in the original trial (n=132 in the perioperative enteral nutrition group and n=133 in the standard care group). At 6months, global quality-of-life (83 vs 83, p=.357) did not differ significantly between the groups. The mean total societal costs for the intervention and standard care groups were €14,673 and €11,974, respectively, but did not reach statistical significance (p=.109). The intervention resulted in an ICER of –€6,276 per point increase in the global quality of life score. The gain in QALY was marginal (0.003), with an additional cost of €2,941, and the ICUR (Incremental cost utility ratio) was estimated at €980,333. Limitations: The cost elements for all the participating centers reflect the reference prices from the Netherlands. Patient-reported questionnaires may have resulted in recall bias. Sample size was limited by exclusion of patients who did not complete questionnaires for at least at two time points. A power analysis based on costs and health-related quality-of-life (HRQoL) was not performed. The economic impact could not be analyzed at 1month post-operatively where the effects could potentially be higher. Conclusions: This study suggests that perioperative nutrition is not beneficial for the patients in terms of quality-of-life and is not cost-effective.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85058997388&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30523724
U2 - https://doi.org/10.1080/13696998.2018.1557200
DO - https://doi.org/10.1080/13696998.2018.1557200
M3 - Article
C2 - 30523724
SN - 1369-6998
VL - 22
SP - 238
EP - 244
JO - Journal of Medical Economics
JF - Journal of Medical Economics
IS - 3
ER -