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
N1 - Funding Information:
The funding for this study was provided by the Netherlands Organisation for Health Research and Development (ZonMW), Fonds NutsOhra, and Danone Research.
Funding Information:
MDPL has received research grants through the institution from Medtronic, Galvani, and KWF. The other coauthors have no conflict of interest relevant to this study. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Publisher Copyright:
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2019/3/4
Y1 - 2019/3/4
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, 3 months, and 6 months. 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 6 months, 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 euro14,673 and euro11,974, respectively, but did not reach statistical significance (p = .109). The intervention resulted in an ICER of -euro6,276 per point increase in the global quality of life score. The gain in QALY was marginal (0.003), with an additional cost of euro2,941, and the ICUR (Incremental cost utility ratio) was estimated at euro980,333. 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 1 month 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, 3 months, and 6 months. 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 6 months, 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 euro14,673 and euro11,974, respectively, but did not reach statistical significance (p = .109). The intervention resulted in an ICER of -euro6,276 per point increase in the global quality of life score. The gain in QALY was marginal (0.003), with an additional cost of euro2,941, and the ICUR (Incremental cost utility ratio) was estimated at euro980,333. 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 1 month 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.
KW - Colorectal surgery
KW - perioperative enteral nutrition
KW - cost-effectiveness
KW - quality-of-life
KW - economic evaluation
KW - QUALITY-OF-LIFE
KW - POSTOPERATIVE ILEUS
KW - ANASTOMOTIC LEAKAGE
KW - COMPLICATIONS
KW - BURDEN
KW - IMPACT
U2 - 10.1080/13696998.2018.1557200
DO - 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 -