Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-25T06:02:51.841Z Has data issue: false hasContentIssue false
  • English
  • Français

A Cost-Utility Analysis of Preoperative Total Parenteral Nutrition

Published online by Cambridge University Press:  10 March 2009

Vivek Goel  and
Allan S. Detsky
Vivek Goel
Affiliation:
University of Toronto
Allan S. Detsky
Affiliation:
University of Toronto
Get access Rights & Permissions [Opens in a new window]

Extract

It has been suggested that preoperative total parentetal nutrition may be used to reduce the risk of nutrition-associated postoperative complications in high-risk patients. These patients can be identified based on their nutritional status. The efficiency of this intervention is assessed using the technique of cost-utility analysis. Data from multiple sources is integrated to perform the economic assessment.

The cost-utility ratios for treating several malnourished patients with localized upper gastrointestinal cancer are below $40,000. These cost-utility ratios compare favorably with published results of other programs. The ratios increase considerably if patients who are better nourished (at lower risk of postoperative complication) receive the intervention. The analysis is very sensitive to the efficacy of the intervention.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 5 , Issue 2 , April 1989 , pp. 183 - 194
Copyright
Copyright © Cambridge University Press 1989

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Anderson, G. F., & Steinberg, E. P.DRGs and specialized nutrition support: Prospective payment and nutritional support: The need for reform. Journal of Parenteral and Enteral Nutrition, 1986, 10, 3–8.CrossRefGoogle ScholarPubMed
American Society of Parenteral and Enteral Nutrition. Guidelines for the use of total parenteral nutrition in the hospitalized adult. Journal of Parenteral and Enteral Nutrition, 1986, 10, 441–45.CrossRefGoogle Scholar
Singer, R. B., & Levinson, L. (eds). Medical risks: Patterns of mortality and survival. Lexington, MA: Lexington Books, 1976.Google Scholar
Beck, J. R., Kassirer, J. P., & Pauker, S. G.A convenient approximation of life expectancy (the “DEALE”): I. Validation of the method. American Journal of Medicine, 1982, 73, 883–88.CrossRefGoogle Scholar
Beck, J. R., Pauker, S. G., Gottlieb, J. E., Klein, K., & Kassirer, J. P.A convenient approximation of life expectancy (the “DEALE”): II. Use in medical decision-making. American Journal of Medicine, 1982, 73, 889–97.CrossRefGoogle ScholarPubMed
Bistrian, B. R., Blackburn, G. L., Hallowell, E., et al. Protein status of general surgical patients. Journal of the American Medical Association, 1974, 230, 858–60.CrossRefGoogle ScholarPubMed
Buzby, G. P., Mullen, J. L., Mathews, D. C., Hobbs, C. L., & Rosato, E. F.Prognostic Nutritional Index in gastrointestinal surgery. American Journal of Surgery, 1980, 139, 160–67.CrossRefGoogle ScholarPubMed
Detsky, A. S., Baker, J. P., O'Rourke, K., et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery. Journal of Parenteral and Enteral Nutrition, 1987, 11, 440–46.CrossRefGoogle ScholarPubMed
Detsky, A. S., Baker, J. P., O'Rourke, K., & Goel, V.Perioperative parenteral nutrition: A meta-analysis. Annals of Internal Medicine, 1987, 107, 195–203.CrossRefGoogle ScholarPubMed
Detsky, A. S., & Jeejeebhoy, K. N.Cost-effectiveness of preoperative parenteral nutrition in patients undergoing major gastrointestinal surgery. Journal of Parenteral and Enteral Nutrition, 1982, 8, 632–37.CrossRefGoogle Scholar
Detsky, A. S., McLaughlin, J. R., Baker, J. P., et al. What is subjective global assessment of nutritional status? Journal of Parenteral and Enteral Nutrition, 1987, 11, 8–13.CrossRefGoogle ScholarPubMed
Detsky, A. S., Mendelson, R. A., Baker, J. P., Jeejeebhoy, K. N.The choice to treat all, some, or no patients undergoing gastrointestinal surgery with nutritional support: A decision analysis approach. Journal of Parenteral and Enteral Nutrition, 1984, 8, 245–53.CrossRefGoogle ScholarPubMed
Drummond, M. F., Stoddart, G. L., & Torrance, G. W.Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 1987.Google Scholar
Foote, S. B.Assessing medical technology assessment: Past, present, and future. The Milbank Quarterly, 1987, 65, 59–80.CrossRefGoogle ScholarPubMed
Goel, V., & Deber, R. B.Cost-utility meets policy development: Nonionic contrast media. Medical Decision Making, 1987, 7, 276.Google Scholar
Health and Public Policy Committee, American College of Physicians. Perioperative parenteral nutrition. Annals of Internal Medicine, 1987, 107, 252–53.CrossRefGoogle Scholar
Jeejeebhoy, K. N., & Bruce-Robertson, A. (eds). Total parenteral nutrition in the hospital and at home. Boca Raton, FL: CRC Press Inc., 1983.Google Scholar
L'Abbe, K. A., Detsky, A. S., & O'Rourke, K. F.Meta-analysis in clinical research. Annals of Internal Medicine, 1987, 107, 224–33.CrossRefGoogle ScholarPubMed
Life Tables, Canada and Provinces–1980–82. Ottawa: Statistics Canada, 1984. Catalogue 84–532, occasional.Google Scholar
Mullen, J. L., Buzby, G. P., Matthews, D. C., et al. Reduction of operative morbidity and mortality by combined pre-operative and post-operative nutritional support. Annals of Surgery, 1980, 192, 604–13.CrossRefGoogle Scholar
Muller, J. M., Brenner, U., Deinst, C., et al. Pre-operative parenteral feedings in patients with gastrointestinal carcinoma. Lancet, 1982, i, 68–71.CrossRefGoogle Scholar
Roberts, D., Thelen, D., & Weinstein, S.Parenteral and enteral nutrition: A cost-benefit analysis. Minnesota Medicine, 1982, 65, 707–10.Google Scholar
Silberman, H.The role of preoperative parenteral nutrition in cancer patients. Cancer, 1985, 55, 254–57.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Steinberg, E. P., & Anderson, G. F. Implications of medicare's prospective payment system for specialized nutrition services. Nutrition in Clinical Practice, 1986, 12–28.CrossRefGoogle Scholar
Torrance, G. W.The measurement of health state utilities for economic appraisal. Journal of Health Economics, 1986, 5, 1–30.CrossRefGoogle ScholarPubMed
Twomey, P. L., & Patching, S. C.Cost-effectiveness of nutritional support. Journal of Parenteral and Enteral Nutrition, 1985, 9, 3–10.CrossRefGoogle ScholarPubMed
U.S. Bureau of Labor Statistics. Monthly Labor Review. 03, 1987.Google Scholar
Weinstein, M. C.Challenges for cost-effectiveness research. Medical Decision Making, 1986, 6, 194–198.CrossRefGoogle ScholarPubMed
Wolfe, D. M., Philips, G. J., & Hodges, R. E.Evaluation and management of nutritional status before surgery. Medical Clinics of North America, 1979, 63, 1257–69.CrossRefGoogle ScholarPubMed