ECONOMIC IMPACT OF HOME PARENTERAL NUTRITION PROGRAMME IMPLEMENTATION: A BUDGET IMPACT ANALYSIS IN ROMANIA
Author(s)
Grzegorz Binowski, MSc1, Anna Packowska, BSc1, Cristian Cobilinsch, MD, PhD2, Gerald Martin Waligora, MD3, Liliana Mirea, MD, Prof2.
1MAHTA Intl. Sp. z o.o., Warsaw, Poland, 2„Carol Davila” University of Medicine and Pharmacy, Bucharest, Bucharest, Romania, 3Baxter Polska Sp z o.o., Warszawa, Poland.
1MAHTA Intl. Sp. z o.o., Warsaw, Poland, 2„Carol Davila” University of Medicine and Pharmacy, Bucharest, Bucharest, Romania, 3Baxter Polska Sp z o.o., Warszawa, Poland.
OBJECTIVES: Home parenteral nutrition (HPN) is an established treatment for chronic intestinal failure, yet Romania currently lacks a dedicated reimbursement pathway, leaving many patients dependent on prolonged hospital-based parenteral nutrition (PN). This study evaluated the financial impact of introducing HPN compared with hospital-based PN over a 5-year period from public payer and hospital perspectives.
METHODS: An ISPOR-aligned, cohort-based, multi-scenario budget impact model estimated the incremental costs of introducing HPN for adults with chronic intestinal failure due to short bowel syndrome. Budget impact was assessed under minimum-, base case-, and maximum-cost scenarios; uptake assumptions were informed by local epidemiology and HPN growth trends in other European countries. Resource utilization and cost inputs were obtained from an anonymized Romanian hospital database linking discharge records with medication-level data and national tariffs. Costs included inpatient care and monitoring, nutritional solutions, complication management, and implementation. Key inputs were varied by ±20%, and multiple uptake scenarios were tested.
RESULTS: In the base case, 37 patients received HPN in year 1, increasing to 185 by year 5. HPN generated annual savings per patient of EUR 1,994 for the public payer and EUR 77,718 for hospitals; annual public payer savings increased from EUR 73,607 in year 1 to EUR 368,033 in year 5. Savings were driven mainly by avoided prolonged inpatient care and complication management, with HPN associated with fewer catheter-related infections and liver dysfunction events. Hospital PN costs EUR 606.41/day compared with EUR 90.80/day for HPN, while DRG reimbursement covered only EUR 152.97/day, leaving EUR 412.25/day uncovered. Results were consistent across scenarios and sensitivity analyses; daily hospital PN costs and duration of hospital PN were the main drivers of hospital savings.
CONCLUSIONS: A structured HPN reimbursement program in Romania could reduce costs for both payer and hospitals while expanding access to a standard of care available in most European countries.
METHODS: An ISPOR-aligned, cohort-based, multi-scenario budget impact model estimated the incremental costs of introducing HPN for adults with chronic intestinal failure due to short bowel syndrome. Budget impact was assessed under minimum-, base case-, and maximum-cost scenarios; uptake assumptions were informed by local epidemiology and HPN growth trends in other European countries. Resource utilization and cost inputs were obtained from an anonymized Romanian hospital database linking discharge records with medication-level data and national tariffs. Costs included inpatient care and monitoring, nutritional solutions, complication management, and implementation. Key inputs were varied by ±20%, and multiple uptake scenarios were tested.
RESULTS: In the base case, 37 patients received HPN in year 1, increasing to 185 by year 5. HPN generated annual savings per patient of EUR 1,994 for the public payer and EUR 77,718 for hospitals; annual public payer savings increased from EUR 73,607 in year 1 to EUR 368,033 in year 5. Savings were driven mainly by avoided prolonged inpatient care and complication management, with HPN associated with fewer catheter-related infections and liver dysfunction events. Hospital PN costs EUR 606.41/day compared with EUR 90.80/day for HPN, while DRG reimbursement covered only EUR 152.97/day, leaving EUR 412.25/day uncovered. Results were consistent across scenarios and sensitivity analyses; daily hospital PN costs and duration of hospital PN were the main drivers of hospital savings.
CONCLUSIONS: A structured HPN reimbursement program in Romania could reduce costs for both payer and hospitals while expanding access to a standard of care available in most European countries.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE28
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Topic Subcategory
Budget Impact Analysis
Disease
Gastrointestinal Disorders, Nutrition