Measuring the economic impact of perioperative total parenteral nutrition: principles and design

Eisenberg, John M.; Glick, Henry A.; Hillman, Alan L.; Baron, Jonathan; Finkler, Steven A.; Hershey, John C.; Lavizzo‐Mourey, Risa; Buzby, Gordon P.

doi:10.1093/ajcn/47.2.382

Cited by 17 publications

(5 citation statements)

References 17 publications

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“…Costing mode of delivery is challenging. Hospital charges are often cited as indication of the cost of care; however, these standard charges rarely reflect the actual cost of providing a service [15]. The actual cost of providing a service is best estimated by identifying, measuring, and valuing all resources used in the production of the service [16], known as the ''bottom-up'' approach or micro-costing.…”

Section: Introductionmentioning

confidence: 99%

At What Price? A Cost-Effectiveness Analysis Comparing Trial of Labour after Previous Caesarean versus Elective Repeat Caesarean Delivery

Fawsitt

Bourke

Greene³

et al. 2013

PLoS ONE

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BackgroundElective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.MethodsUsing a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both “bottom-up” and “top-down” costing estimations.ResultsMaternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD (€1,835.06 versus €4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis.ConclusionsClinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model.

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Section: Introductionmentioning

confidence: 99%

At What Price? A Cost-Effectiveness Analysis Comparing Trial of Labour after Previous Caesarean versus Elective Repeat Caesarean Delivery

Fawsitt

Bourke

Greene³

et al. 2013

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Hospital charges are often cited as indication of the cost of care; however, these standard charges rarely reflect the actual cost of providing a service [15]. The actual cost of providing a service is best estimated by identifying, measuring, and valuing all resources used in the production of the service [16], known as the ''bottom-up'' approach or micro-costing.…”

Section: Introductionmentioning

confidence: 99%

At what price? a cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery

Fawsitt¹,

Bourke

Greene

et al. 2012

Arch Dis Child Fetal Neonatal Ed

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Background: Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.

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“…Twomey's [8 11 study suggested a saving of $1,70O/patient with preoperative TPN. Eisenberg et al [84] outlined the principles of the utopian cost/benefit perioperative TPN study and noted there is no optimal study to prove it.…”

Section: Cost Effectivenessmentioning

confidence: 99%

Nutritional assessment and the role of preoperative parenteral nutrition in the colon cancer patient

Vitello

1994

Seminars in Surgical Oncology

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Hospital-based malnutrition is prevalent, especially among patients with gastrointestinal malignancy. Colorectal cancers produce malnutrition through impairment of gastrointestinal function and the liberation of cytokines. Malnourished patients who undergo operation have an increased likelihood of perioperative morbidity and mortality. The performance of a nutritional assessment will aid in the recognition of such patients and provide a risk assessment profile. Preoperative parenteral nutrition is a major expense and delays surgical intervention. Studies to document the efficacy of preoperative parenteral nutrition suffer from design flaws and small sample sizes. Studies that exclusively address patients with cancer of the colon and rectum are absent; therefore results must be extrapolated from the existing literature. Cumulative evidence suggests that a 7-10 day period of parenteral nutrition repletion in the severely malnourished patient will diminish the incidence of postoperative septic complications and mortality. The preoperative treatment of lesser degrees of malnutrition remain controversial. Once the decision has been made to institute preoperative parenteral alimentation, attention to the details of protein requirements and caloric needs should be stressed. The endpoint of therapy is poorly defined. The role of glutamine, arginine, omega-3 fatty acids, and growth hormone in the preoperative repletion process provide an exciting arena for future research.

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Measuring the economic impact of perioperative total parenteral nutrition: principles and design

Cited by 17 publications

References 17 publications

At What Price? A Cost-Effectiveness Analysis Comparing Trial of Labour after Previous Caesarean versus Elective Repeat Caesarean Delivery

At What Price? A Cost-Effectiveness Analysis Comparing Trial of Labour after Previous Caesarean versus Elective Repeat Caesarean Delivery

At what price? a cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery

Nutritional assessment and the role of preoperative parenteral nutrition in the colon cancer patient

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