Crit Care:危重症儿童早期和晚期启动肠外营养的成本效益分析!

2018-01-16 xing.T MedSci原创

由此可见,PN的延迟启动降低了危重症儿童住院的直接医疗费用,超出了停止PN的预期成本。通过延迟启动PN来避免新的感染大大地降低了成本。因此,PN的晚期启动优于PN的早期启动,主要通过其对新发感染的影响。

多中心随机对照试验显示危重症患儿第一周内停止肠外营养(PN)在临床上优于提供早期PN的患儿。近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,这项研究描述了这种新的营养策略的成本效益。

研究人员使用微观成本法计算了直接医疗费用,研究人员比较了从医院的角度使用Student's t检验比较了研究人群中晚期与早期开始PN治疗(n=673 vs. n=670例患者)的成本,并确定了主要成本驱动因素,评估了新感染对总成本的影响。

晚期开始PN治疗的患者的平均直接医疗费用(26.680欧元,IQR为10.090-28.830欧元/患者)比接受早期PN治疗的患者(33.860欧元,IQR为11.080-34.720欧元/患者)要低21%(-7.180欧元,P=0.007)。由于晚期开始PN治疗效果更好,成本更低,这一策略优于早期开始PN治疗。PN降低的成本仅占总成本降低的2.1%。主要的成本驱动因素是重症监护室住院费用(-4.120欧元,P=0.003)。获得新感染的患者(14%)占总成本的41%。敏感性分析证实了两个医疗系统的一致性。

由此可见,PN的延迟启动降低了危重症儿童住院的直接医疗费用,超出了停止PN的预期成本。通过延迟启动PN来避免新的感染大大地降低了成本。因此,PN的晚期启动优于PN的早期启动,主要通过其对新发感染的影响。

原始出处:

Esther van Puffelen,et al. Cost-effectiveness study of early versus late parenteral nutrition in critically ill children (PEPaNIC): preplanned secondary analysis of a multicentre randomised controlled trial.Critical Care.2018. https://doi.org/10.1186/s13054-017-1936-2


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