An economic evaluation of perioperative enteral nutrition in patients undergoing colorectal surgery (SANICS II study) |
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| Authors: | Madhuri Pattamatta Silvia M A A Evers Boudewijn J J Smeets Emmeline G Peters Misha D P Luyer |
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| Institution: | 1. Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands;2. Trimbos Institute of Mental Health and Addiction, Center for Economic Evaluations, Utrecht, The Netherlands;3. Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands;4. GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands;5. Tytgat Institute for Liver and Intestinal Research, Academic Medical Center Amsterdam, Amsterdam, The Netherlands |
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| Abstract: | Aims: The objective of this (trial based) economic evaluation was to assess, from a societal perspective, the cost-effectiveness of perioperative enteral nutrition compared with standard care in patients undergoing colorectal surgery.Materials and methods: Alongside the SANICS II randomized controlled trial, global quality-of-life, utilities (measured by EQ-5D-5L), healthcare costs, production losses, and patient and family costs were assessed at baseline, 3?months, and 6?months. Incremental cost-effectiveness ratios (ICERs) (i.e. cost per increased global quality-of-life score or quality-adjusted life year QALY] gained) and cost effectiveness acceptability curves were visualized.Results: In total, 265 patients were included in the original trial (n?=?132 in the perioperative enteral nutrition group and n?=?133 in the standard care group). At 6?months, global quality-of-life (83 vs 83, p?=?.357) did not differ significantly between the groups. The mean total societal costs for the intervention and standard care groups were €14,673 and €11,974, respectively, but did not reach statistical significance (p?=?.109). The intervention resulted in an ICER of –€6,276 per point increase in the global quality of life score. The gain in QALY was marginal (0.003), with an additional cost of €2,941, and the ICUR (Incremental cost utility ratio) was estimated at €980,333.Limitations: The cost elements for all the participating centers reflect the reference prices from the Netherlands. Patient-reported questionnaires may have resulted in recall bias. Sample size was limited by exclusion of patients who did not complete questionnaires for at least at two time points. A power analysis based on costs and health-related quality-of-life (HRQoL) was not performed. The economic impact could not be analyzed at 1?month post-operatively where the effects could potentially be higher.Conclusions: This study suggests that perioperative nutrition is not beneficial for the patients in terms of quality-of-life and is not cost-effective.Trial registration: ClinicalTrials.gov identifier: NCT02175979.Trial registration: Netherlands National Trial Register identifier: NTR4670. |
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| Keywords: | Colorectal surgery perioperative enteral nutrition cost-effectiveness quality-of-life economic evaluation |
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