Infection Risk and Cost-Effectiveness of Commercial Bags or Glass Bottles for Total Parenteral Nutrition

Abstract

The baseline cost-minimization analysis concluded that the extra cost of TPN bags was not justified by the extra savings. The cost-effectiveness analysis, however, found that the cost per life saved fell within the accepted range of public health interventions, provided a large fraction of infections are averted using TPN bags.

ESPEN Guidelines on Parenteral Nutrition: Intensive care

“…The separate containers approach requires numerous IV line manipulations associated with an increased risk of administration errors, as well as of septic and metabolic complications. 22 In a prospective, randomized, unblinded, controlled study, 23 separate containers, hospital-compounded bags and all-in-one bags were compared. PN-related activities of medical, nursing and pharmacy staff were timed.…”

Clinical, Ergonomic, and Economic Outcomes With Multichamber Bags Compared With (Hospital) Pharmacy Compounded Bags and Multibottle Systems: A Systematic Literature Review

“…Of these, 18 met the selection criteria and were included in the systematic review (Figure 1). 3 , 26 – 43 …”

“…Among the 18 studies included in the review, there was 1 large prospective RCT, 27 6 observational studies, 28 – 33 9 cost‐analysis studies, 3 , 34 – 41 and 2 health economic models 42 , 43 . Geographically, 6 studies were conducted in the United States 28 , 29 , 31 – 34 ; 2 studies each were conducted in France, 37 , 43 Germany, 30 , 39 and Spain 35 , 36 ; and 1 study each was conducted in Canada, 42 Italy, 41 Switzerland, 3 Turkey, 40 and the United Kingdom 38 . One study was conducted across 3 Latin American countries (Argentina, Brazil, and Guatemala) 27 …”

“…A total of 10 studies evaluated 1 or more clinical outcomes, 27 – 34 , 36 , 42 including nutrition efficacy, 32 , 33 , 36 infectious complications, 27 – 31 , 34 , 36 , 42 length of stay in the hospital or intensive care unit (ICU), 27 , 28 , 31 , 33 , 34 , 41 and mortality 27 , 31 , 42 . Sixteen studies evaluated ergonomic and/or economic outcomes 3 , 27 , 30 – 43 . Of these, 6 studies assessed ergonomic outcomes such as time to prepare and administer PN 3 , 27 , 33 , 35 , 38 , 39 .…”

“…Of these, 6 studies assessed ergonomic outcomes such as time to prepare and administer PN 3 , 27 , 33 , 35 , 38 , 39 . A majority of studies evaluating economic outcomes compared the direct acquisition and administration costs of selected PN preparations; only 5 studies evaluated total hospitalization costs in the context of patient outcomes such as infectious complications and length of stay in the hospital or ICU 30 , 31 , 34 , 42 , 43 . Of note, none of the included studies evaluated errors associated with the PN use process.…”