Acost-effectivenessstudyofenteralimmunemodulating.pptVIP

A cost-effectiveness study of enteral immune modulating nutrition in intensive care patients Elizabeth Coates Clare Hibbert Medical Economics and Research Centre, Sheffield MERCS CIMC 2001 What is immunonutrition? The term given to describe special enteral feeds containing: Arginine Omega-3 fatty acids Nucleotides and sometimes, glutamine 1. The nature of critically ill patients’ conditions Malnutrition Compromise of immune system Infection All these increase: Length of ICU and hospital stay Morbidity Mortality Resource consumption Costs of care 2. Growing evidence on the benefits of immunonutrition… 3. Despite these findings, and the increasing pressure to curtail expenditure The cost-effectiveness issue has rarely been explored… Aim of the study To estimate the cost-effectiveness of immunonutrition IMN in reducing infection rates in critically ill adult patients when compared with standard enteral nutrition. Outcome measure A reduction in the duration of days of infection in ICU patients with sepsis from NHS perspective Literature search Databases MedLine Embase CINAHL Search terms Immunonutriton Nutrition Enteral feed Intensive care Critical care Costs Cost-effectiveness analysis Studies of IMN Atkinson 1998 reduced ICU hospital LOS and duration of ventilation Bower 1995 reduction in acquired infections and hospital LOS Galban 2000 reduction in infection rate and lower mortality rate Key paper Beale et al. Immunonutrition in the critically ill: A systematic review of clinical outcome. Critical Care Medicine 1999; 27:12: 2799-2805. Benefits of immunonutrition? Methodology The evaluation of cost-effectiveness was based on two factors: Evidence of effectiveness of IMN from the 12 RCTs included in the meta-analysis 1482 patients Retrospective cost data on individual ICU patients at the Royal Hallamshire Hospital RCTs included in the meta-analysis Evaluation of the clinical evidence Assessment of the studies’ quality using the