Early enteral nutrition in critical illness: a full economic analysis using US costs

Gordon S Doig,1 Hélène Chevrou-Séverac,1,2 Fiona Simpson1 1Northern Clinical School Intensive Care Research Unit, University of Sydney, Sydney, NSW, Australia; 2Global Head of Health Economics, Nestlé Health Sciences, Vevey, Switzerland Purpose: Although published meta-analyses demonstrate patient survival may be improved if enteral nutrition (EN) is provided to critically ill patients within 24 hours of injury or admission to the intensive care unit (ICU), these publications did not investigate the impact of early EN on measures of health care resource consumption and total costs. Materials and methods: From the perspective of the US acute care hospital system, a cost-effectiveness analysis was undertaken based on a large-scale Monte Carlo simulation (N = 1,000,000 trials) of a 1,000-patient stochastic model, developed using clinical outcomes and measures of resource consumption reported by published meta-analyses combined with cost distributions obtained from the published literature. The mean cost differences between early EN and standard care, along with respective 95% confidence intervals, were obtained using the percentile method. Results and conclusion: The provision of early EN to critically ill patients is a dominant technology: Patient survival is significantly improved and total costs of care reduced meaningfully. Under conservative assumptions, the total costs of acute hospital care were reduced by US$14,462 per patient (95% confidence interval US$5,464 to US$23,669). These results were robust, with all sensitivity analyses demonstrating significant savings attributable to the use of early EN, including sensitivity analysis conducted using European cost data. Keywords: intensive care, costs, cost-effectiveness analysis, nutritional support, critical care, enteral feeding, meta-analysis