DSL-006 Cost Analysis of Adult Parenteral Nutrition Systems: Three-Compartment Bag Versus Customised

Abstract

Background Parenteral nutrition (PN) is a costly technology used widely to provide nutrition to patients who have an inaccessible or non-functioning intestine. Two all-in-one systems currently being used are customised formulations, prepared by hospital pharmacies, and three-compartment bags. Purpose To provide a systematic cost comparison of the two all-inone PN systems: individualised (made from nutrient solutions) versus manufactured (made from three-compartment bag), both prepared in hospital pharmacies. Materials and MethodsWe conducted a prospective study to analyse the total cost of PN bags, accounting for all of the processes involved in preparing and delivering them (the cost of manpower, nutrition solutions, medical supplies and quality controls) in three different healthcare settings. To compare therapeutic alternatives of equivalent nutritional value, the study was performed for the most frequently-employed formulation, which was similar to commercial preparations. A univariate sensitivity analysis was performed to evaluate the impact of different rates of use of three-compartment PN bags. Results 157 routine acts of PN bag preparation (65 hospital compounded and 92 three-compartment) were observed and timed over 9 days. Total costs of the 157 PN bags were included in the study. Mean costs of hospital-compounded bags were higher than threecompartment bags, 51.16 ± 5.63€ versus 39.69 ± 3.00€ respectively (p < 0.01). Manpower costs were responsible for the majority of the differences found (70%). In scenarios using a three-compartment system for 30%, 70% and 90% of PN provision, a cost savings of 4.3%, 10.1% and 12.9% respectively could be achieved. Greatest rates of changing from hospital compounded bags (70% and 90%), in a hospital with 1,800 PN bags/year, might reduce the annual budget by 9306€ and 11,964.8€, respectively. Meanwhile, in a large facility the savings for 8,000 TPN days would be 64,248€ and 82,605€, respectively. Conclusions Since we need to reduce the costs of effective treatments, three-compartment bags could be used for standard adult PN to save money.

Cost, Time, and Error Assessment During Preparation of Parenteral Nutrition: Multichamber Bags Versus Hospital‐Compounded Bags

“…In a study over a 10‐day period in an intensive care unit in Germany, a cost savings was demonstrated using MCBs when compared with multibottle systems . Similarly, a smaller, prospective study from 3 Spanish hospitals reported significantly higher mean costs for COBs compared with MCBs . Additionally, a retrospective study showed an average savings per standardized premixed PN bags compared with customized PN solutions .…”

Determining Efficacy, Safety, and Preparation of Standardized Parenteral Nutrition

“…PN monobag preparation times reported in the literature range widely from 20 minutes to 12 hours depending on the time from prescription to start of PN. [2][3][4][5][6][7] Time savings for each multichamber PN bag prepared in these studies range from 12 to 60 minutes and represents a cumulative benefit for institutions compounding more PN prescriptions (assuming equivalent patient outcomes). Discounting the possibility that the investigators were overly conservative in their reporting of PN regimen preparation time, their affirmation that multichamber bags simplifies preparation is reasonable.…”

“…Considering the complexity of a PN monobag formulation and the number of components required, a mean preparation time of 12 minutes speaks either to the efficiency of the institution or the flawed timing methodology used. PN monobag preparation times reported in the literature range widely from 20 minutes to 12 hours depending on the time from prescription to start of PN . Time savings for each multichamber PN bag prepared in these studies range from 12 to 60 minutes and represents a cumulative benefit for institutions compounding more PN prescriptions (assuming equivalent patient outcomes).…”

Premixed Multichamber Bags Versus Compounded Parenteral Nutrition (Cost Debate)

“…[27][28][29][30][31][32][33] Yine, yapılan çalışmalarda BDE'lerin sıkı laboratuvar ve klinik monitorizasyona bağlı olarak elektrolit dengesizlikleri gibi metabolik komplikasyonları önemli ölçüde azalttığı, sepsis, pnömotoraks gibi kateterle ilişkili komplikasyonların, nütrisyon konusunda eğitimli bir takım ve/veya tecrübeli hekimlerle azalabilmekte olduğu ve klinik bakımın kalitesini artırarak maliyeti azalttığı; nütrisyon takımının önerilerinin mali avantajlar sağlayabileceği bildirilmiştir 4,5,[34][35][36][37][38][39] Bununla beraber, compounder sisteminin uygulanabilmesi için aseptik ortam şartı ve dolum işleminde görevli eğitimli personel şartı vardır. 40,41 Dolayısıyla ideal sonuçlar için günlük parenteral beslenen hasta sayısı çok önemlidir. ANEAH'daki yoğun bakım yatak sayıları ve kritik hasta yoğunluğu göz önünde bulundurulduğunda, hastaya özel hazırla-nan PN ürünlerin hastanın tedavisini olumlu yönde etkileyebileceği düşünülmektedir.…”

“…40,43 Ancak, özellikle 3. basamak yoğun bakım hizmetlerinde, özellikli hasta yoğunluğunun fazla olması, bu hastaların spesifik ürün ihtiyacı, sayılan avantajların değerlendirilmesini zorunlu kılmaktadır.…”