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Preoperative Immunonutrition: Cost-Benefit Analysis

Marco Braga, MD^* and Luca Gianotti, MD, ScD

From the ^* Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy; and the Department of Surgery, Milano-Bicocca University, Milan, Italy

Correspondence: Marco Braga, MD, Department of Surgery, San Raffaele Hospital Via Olgettina 60, 20132 Milan, Italy. Electronic mail may be sent to braga.marco{at}hsr.it.

Background: To evaluate whether preoperative immunonutrition might lead to a savings in patient care. Data on resources consumed to treat postoperative complications are scanty, but morbidity costs continue to be a major burden for any health care system. A recent randomized clinical trial carried out in well-nourished patients with gastrointestinal cancer showed that a 5-day preoperative oral immunonutrition reduced postoperative morbidity compared with conventional treatment (no supplementation). Methods: The abovementioned trial was the basis for the economic evaluation. In-hospital related costs of routine surgical care and costs of nutrition were calculated. Estimates of complication costs were based on both resources used for treatment and additional length of hospital stay. Cost comparison and cost-effectiveness analysis were then carried out. Results: Total cost of nutrition was 3407 in the conventional group and 14,729 in the preoperative group. In patients without complication, the cost of in-hospital routine care was similar in both groups. The mean cost of complication was 6178 in the conventional group and 4639 in the preoperative group (p = .05). Total cost of patients with complications was 535,236 in the conventional group and 334,148 in the preoperative group. Total costs consumed 93% of the diagnosis-related-group (DRG) reimbursement rate in the conventional group and 78% in the preoperative group. Cost-effectiveness was 6245 for the conventional group and 2985 for the preoperative group. Conclusions: The costs of postoperative morbidity consumed a large amount of the DRG reimbursement rate. Preoperative immunonutrition was cost-effective in our series.

Journal of Parenteral and Enteral Nutrition, Vol. 29, No. 1 suppl, S57-S61 (2005)
DOI: 10.1177/01486071050290S1S57


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