Cost-effectiveness Analysis of Feeding Guidelines for Infants Following Intestinal Surgery. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Shores, Darla R.; Mogul, Douglas; Allen, Julia; Delarmente, Benjo A.; Padula, William
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 70:Issue 5(2020)
• Publication Date: 2020-05
• Subjects: intestinal failure -- intestinal failure–associated liver disease -- short bowel syndrome; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000002642
• Languages: English
• ISSNs: 0277-2116

Abstract

ABSTRACT: Objective: The aim of the study was to determine the cost-effectiveness of postoperative feeding guidelines to reduce complications in infants with intestinal surgery compared to standard feeding practices. Methods: Using outcomes from a cohort study, Markov models from health care and societal perspectives simulated costs per hospitalization among infants fed via guidelines versus standard practice. Short-term outcomes included intestinal failure–associated liver disease, necrotizing enterocolitis after feeding, sepsis, and mortality. Effectiveness was measured as length of stay. The incremental cost-effectiveness ratios (ICER) compared cost over length of stay. Univariate and multivariate probabilistic sensitivity analyses with 10, 000 Monte Carlo Simulations were performed. A second decision tree model captured the cost per quality-adjusted life years (QALYs) using utilities associated with long-term outcomes (liver cirrhosis and transplantation). Results: In the hospital perspective, standard feeding had a cost of $31, 258, 902 and 8296 hospital days, and the feeding guidelines had a cost of $29, 295, 553 and 8096 hospital days. The ICER was $−9832 per hospital stay with guideline use. More than 90% of the ICERs were in the dominant quadrant. Results were similar for the societal perspective. Long-term costs and utilities in the guideline group were $2830 and 0.91, respectively, versus $4030 and 0.90, resulting in an ICER of $−91, 756/QALY. Conclusion: In our models, feeding guideline use resulted in cost savings and reduction in hospital stay in the short-term and cost savings and an increase in QALYs in the long-term. Using a systematic approach to feed surgical infants appears to reduce costly complications, but further data from a larger cohort are needed. Abstract : Supplemental Digital Content is available in the text