OBJECTIVES : Economic modelling to evaluate potential cost and clinical effects of including 3CBs in parenteral nutrition (PN) regimens for preterm neonates.

METHODS : A deterministic cost-consequence analysis was performed to estimate hospital costs and clinical impact of a 10% increased utilisation of 3CBs in preterm neonatal population in Belgium, Portugal, Spain and the UK. Included data variables were ingredients, consumables, staff-time and PN associated compounding errors, complications, and clinical events avoided or gained. Five PN preparation methods were considered: pharmacy (manual or automated), ward, outsourced third party and 3CBs with an estimated compounding error rate baseline of 37%, 22%, 37%, 1.7%, and 1%, respectively, derived from Flynn 1997 and Dickson 1993. Infection rate estimates of 0.66% per day of PN for manual pharmacy compounding, which was increased by 10% with ward compounding, and decreased by 10% and 19% with outsourced compounding and 3CBs, respectively which were calculated from Hoang 2008.

RESULTS : Across four countries, in approximately 120,000 preterm neonatal births annually, 52% are estimated to receive PN regimens. The overall current estimated share of PN preparation methods is 64% in manual and 9% in automated pharmacy, 4% in ward, 13% outsourced and 10% pediatric 3CBs. Increasing 3CBs utilization by 10 % would lead to 57% manual, 8% automated, 3% ward and 13% outsourced distribution, and as a result, an estimated 91 blood stream infections, 47 severe compounding errors, and 406 significant compounding errors can be avoided annually. Additionally, up to 17 pharmacists, 17 pharmacy assistants and 8 neonatologists could optimise their time in provision of care. The overall potential incremental hospital cost-savings would be around € 2.6 million across four European countries.

CONCLUSIONS : The use of pediatric 3CBs may provide substantial cost-savings to hospitals and clinical benefits to preterm neonates.