OBJECTIVES: Management of severely malnourished adults often requires parenteral nutrition (PN) as a life-sustaining feeding mode in patients with intestinal failure. Different types of PN are commercially available. The choice of an optimal treatment should be made considering their benefits, harms and costs. This study aimed to establish cost-effectiveness of different types of PN based on a systematic review.

METHODS: A comprehensive literature search was performed in PubMed/Medline and Tufts registry for economic evaluations published since 2000 through 2017. Full economic evaluations that compared different parenteral fluids in malnourished adults published in English were included. Quality of the studies was assessed using 24-item Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

RESULTS: Forty-seven potentially relevant articles were found, with 6 satisfying predefined inclusion criteria. The studies evaluated different PN formulations enriched with either omega-3 fatty-acid lipid emulsions (n=4), glutamine (n=2) or structured triglyceride (STG)-based emulsions (n=1) compared to standard PN. The studies captured patient (n=3), hospital (n=2) and healthcare provider perspective (n=1), analyzing context of European countries (n=3) or China (n=3) and most of them were cost-effectiveness analyses (n=5). Five studies were model-based economic evaluations with four of them applying discrete event simulation. None of the studies reported cost per quality-adjusted life year. Special PN formulations appeared to be cost-effective when compared to standard PN. The CHEERS assessment resulted in total score of 16.3 (SD=4.42), with none of the studies reporting discount rates or measurement and valuation of preference based outcomes and with only one study characterizing heterogeneity.

CONCLUSIONS: Addition of omega-3 lipids, glutamines or structured triglyceride-based emulsions into parenteral fluids appear to be generally cost-effective from the study perspectives. The lack of a well-designed pharmacoeconomic analysis highlights the need for further economic evaluations, which will provide a rationale for the informed healthcare decision-making.