OBJECTIVES: To determine, from the Mexican public health system, if the use of a pediatric standardized parental nutrition is cost-effective vs current use of individualized compounded parental nutrition.

METHODS: A complete cost-effectiveness model comparing a pediatric standardized parental nutrition bag (Numetzah® G13) versus individualized compounded parental nutrition was performed around three groups of neonatal patients with different ranges of birth body weights who require parental nutrition therapy for 7 days:

1. 1 ≥ kg
2. 1 ≤ 1.5 kg
3. 6 ≤ 2 kg

Daily nutritional requirements for each group were set in accordance with NICE guidelines.

A decision-tree type model was developed on the clinical efficacy rates published by Evering (2017). Efficacy was measured as a percentage of patients free of infection (sepsis). Costs were determined by incorporating individual components in the elaboration of compounded PN published on national tenders by the Social Security Mexican Institute (IMSS). Only direct costs were included in the model (PN and Infecction cost); the cost for Numetzah® G13 was $69 USD. The cost for treating an episode of sepsis in neonates was estimated from the Diagnostic Related Groups published by IMSS and updated to May 2022 prices, which came to be $4,636 USD.

Univariate sensitivity analysis was performed with parameters that could generate uncertainty in the model (price, efficacy and complication costs). Additionally, a Monte Carlo simulation performed with 1,000 iterations.

RESULTS: The cost-effectiveness analysis positioned Numetzah® G13 as the dominant alternative over individualized compounded PN bags in all three groups of patients, allowing 20.2% more patients free of infection at a lower cost: $-2,413 usd (1≥kg), $-2,419 usd (1.1≤1.5 kg) and $-2,425 usd (1.6≤2kg). The robustness of the model was verified through the sensitivity analyzes proposed.

CONCLUSIONS: Although PN therapy costs were lower than compounded bags, Numetzah® showed to be the dominant alternative.