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EFFECTIVENESS AND COST-EFFECTIVENESS OF SUPPLEMENTAL GLUTAMINE DIPEPTIDE IN TOTAL PARENTERAL NUTRITION THERAPY FOR CRITICALLY ILL PATIENTS: A DISCRETE EVENT SIMULATION MODEL BASED ON ITALIAN DATA

Published online by Cambridge University Press:  23 January 2012

Lorenzo Pradelli ,
Sergio Iannazzo ,
Orietta Zaniolo ,
Maurizio Muscaritoli  and
Mario Eandi
Lorenzo Pradelli
Affiliation:
Adres Health [email protected]
Sergio Iannazzo
Affiliation:
Adres Health Economics
Orietta Zaniolo
Affiliation:
Adres Health Economics
Maurizio Muscaritoli
Affiliation:
Università di Roma
Mario Eandi
Affiliation:
Università di Torino
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Abstract

Introduction: The supplementation of alanyl-glutamine dipeptide in critically ill patients necessitating total parenteral nutrition (TPN) improves clinical outcomes, reducing mortality, infection rate, and shortening intensive care unit (ICU) hospital lengths of stay (LOSs), as compared to standard TPN regimens.

Methods: A Discrete Event Simulation model that incorporates outcomes rates from 200 Italian ICUs for over 60,000 patients, alanyl-glutamine dipeptide efficacy data synthesized by means of a Bayesian random effects meta-analysis, and national cost data has been developed to evaluate the alternatives from the cost perspective of the hospital. Simulated clinical outcomes are death and infection rates in ICU, death rate in general ward, and hospital LOSs. Sensitivity analyses are performed by varying all uncertain parameter values in a plausible range.

Results: The internal validation process confirmed the accuracy of the model in replicating observed clinical data. Alanyl-glutamine dipeptide on average results more effective and less costly than standard TPN: reduced mortality rate (24.6% ± 1.6% vs. 34.5% ± 2.1%), infection rate (13.8% ± 2.9% vs. 18.8% ± 3.9%), and hospital LOS (24.9 ± 0.3 vs. 26.0 ± 0.3 days) come at a lower total cost per patient (23,409 ± 3,345 vs. 24,161 ± 3,523 Euro).Treatment cost is completely offset by savings on ICU and antibiotic costs. Sensitivity analyses confirmed the robustness of these results.

Conclusions: Alanyl-glutamine dipeptide is expected to improve clinical outcomes and to do so with a concurrent saving for the Italian hospital.

Keywords

Total parenteral nutritionalanylglutamineIntensive care unit
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 1 , January 2012 , pp. 22 - 28
Copyright
Copyright © Cambridge University Press 2012

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