Real‐World Evidence of Treatment, Tolerance, Healthcare Utilization, and Costs Among Postacute Care Adult Patients Receiving Enteral Peptide‐Based Diets in the United States

Abstract

Objective: Peptide -based (PB) enteral tube feeding (ETF) formulas have been shown to reduce gastrointestinal (GI) intolerance in patients receiving enteral nutrition. However, limited data exist in relation to their use in the postacute/home care setting. We sought to assess the real-world GI tolerance, healthcare utilization, and resource use costs of 100% whey-protein PB ETF in adults in a postacute care setting and describe their demographic, clinical, and treatment characteristics.Method: Using medical claims data from the United States, we analyzed GI intolerance events occurring in adults receiving 100% whey-protein PB ETF (Peptamen ® adult formulas) for one year before and after initiation of ETF. Resource use costs were subsequently estimated using a multivariate general linearized model and adjusted for age, gender, and Charlson Comorbidity Index score.

Transition to peptide‐based diet improved enteral nutrition tolerance and decreased healthcare utilization in pediatric home enteral nutrition

“…A review of >1000 insurance claims for patients who received EN has found that transition to PBD in home‐care adults previously receiving oral and enteral SPF reduced hospitalizations and overall cost of care. 14 LaValle et al noted a significant increment ( P < .001) in EN tolerance by 18% with transition to PBD over 1 year. Moreover, a 28% reduction in at least one hospitalization over a period of 1 year was found in those who transitioned to 100% whey protein PBD.…”

“…In fact, healthcare utilization related to EFI can be significant and lead to a higher cost of care and/or overwhelming nutrition care for patients and caregivers. A review of >1000 insurance claims for patients who received EN has found that transition to PBD in home‐care adults previously receiving oral and enteral SPF reduced hospitalizations and overall cost of care 14 . LaValle et al noted a significant increment ( P < .001) in EN tolerance by 18% with transition to PBD over 1 year.…”

“…Although it is difficult to translate utilization to a dollar value, associated cost is expected to be significant. For example, in many estimates, one visit to the ER with GI symptoms may cost $2000–$3500 13,14,27,28 . LaValle et al also showed that the majority of adult patients who received PBD had commercial insurance compared with government‐sponsored programs (ie, Medicare, Medicaid), which may signify reduced access to these formulas.…”

“… 13 The transition to PBD in EFI resulted in significant reduction in healthcare utilization in addition to improvement in GI tolerance. 13 , 14 In the pediatric population, studies have also noted better EN tolerance with PBD, although the data have been limited to critically ill cohorts. 15 , 16 Data for children receiving HEN are lacking despite the need to establish meaningful intervention to help optimize nutrition support for EN‐intolerant children, in order to support their growth and development.…”

“…Recently, transition to peptide‐based diet (PBD) was reported to be beneficial in adult HEN patients intolerant to SPF 13 . The transition to PBD in EFI resulted in significant reduction in healthcare utilization in addition to improvement in GI tolerance 13,14 . In the pediatric population, studies have also noted better EN tolerance with PBD, although the data have been limited to critically ill cohorts 15,16 .…”