OBJECTIVES: Energy needs in critically ill patients vary by condition and are dynamic throughout the patients’ hospital length of stay. Indirect Calorimetry (IC) is recommended by international guidelines for assessing energy needs in order to optimize nutritional support. However, predictive equations are often used instead, demonstrating accuracy only up to 50% of the time. This potentially leads to under or overfeeding, resulting in increased risk of hospital infections and associated costs. We evaluated the potential cost savings and clinical impact from using IC rather than predictive equations to determine energy needs.

METHODS: A deterministic cost-consequences analysis compared IC with predictive equations in critically ill patients in the intensive care (ICU) setting. Risks and increased rates of infections due to underfeeding and overfeeding were derived from literature. This was combined with direct hospital cost data from Belgium, Canada, France, Germany and UK.

RESULTS: Due to predictive equations, the number of patients at risk of inadequate nutritional intake due to under and overfeeding were estimated to be 20% and 12%, respectively. The rate of infections per patient that could be avoided if IC were used to accurately measure energy needs was estimated at 5% for underfed patients and 4% for overfed patients. Total annual net cost-savings per infection avoided ranged from €9,786 in Belgium to €24,820 (C$36,950) in Canada. Total net cost-savings per patient eligible for IC ranged from €149 in Belgium to €373 (C$555) in Canada. The sensitivity analysis showed that even with the lowest infection risks, there were notable hospital cost-savings in the IC scenario.

CONCLUSIONS: The use of IC to accurately measure energy needs for adequate nutritional support can provide cost savings by reducing the risk of infections associated with underfeeding and overfeeding in the ICU. IC should be considered to manage critically ill patients helping improve clinical outcomes and optimise hospital resources.