OBJECTIVES : Malnutrition is highly prevalent in cancer patients and is associated with poorer outcomes. In patients receiving enteral nutrition (EN; tube feeding) for whom nutritional intake remains inadequate, guidelines recommend the use of supplemental parenteral nutrition (SPN; intravenous feeding); however, the cost-effectiveness of this approach has not been established. This analysis assessed the potential cost-effectiveness of SPN in cancer patients with inadequate nutritional intake despite EN.

METHODS : A literature review was performed to identify clinical and health-related quality of life (HRQoL) evidence for SPN in oncology. On this basis, a partitioned survival model was developed in stage IV pancreatic cancer, comparing home-based SPN in addition to EN against EN alone over a lifetime time horizon, from the perspective of the UK National Health Service. The treatment effects of SPN on survival and HRQoL were estimated indirectly based on reported relationships between malnutrition markers and outcomes. Where potential effects for SPN were identified but could not be quantified (reductions in hospitalisation and adverse events), exploratory values were considered.

RESULTS : Estimates of the hazard ratio for SPN on survival ranged between 0.80–0.94 (base-case: 0.87), increasing modelled life expectancy by 1.3 months (+11%). The estimated utility increment was 0.29. The use of SPN was associated with additional costs of £6,110-£13,184 (dependent on whether nursing and home delivery for EN and SPN are provided separately) and 0.14 additional quality-adjusted life-years (QALYs); estimated cost-effectiveness was £43,325–£93,477 per QALY.

CONCLUSIONS : The use of SPN in cancer patients may lead to improved survival and HRQoL, and reduced hospitalisation and adverse events. The cost-effectiveness of SPN may be improved if home delivery and nursing for EN and SPN are consolidated into one service. Further research is required to identify direct evidence on the costs and outcomes associated with SPN, and to determine whether earlier intervention with SPN could improve cost-effectiveness.