OBJECTIVES:

This study aims to assess the economic consequences of the investment in the clinical nutrition network to support the growing need for home artificial nutrition (HAN) in Piedmont, Italy, known for its excellence in the field.

METHODS:

Future growing demand for HAN is predicted by a validated model (Multi Input Single Output –MISO) based on historical data on AN-generating pathologies and medical procedures, and associated HAN cases, recorded by the clinical nutrition centres in Piedmont over 20 years.

Since 2014, 29 full-time healthcare professional equivalents have managed HAN. Owing to excess workload in clinical nutrition centres, new patients suitable for HAN are increasingly withheld in ward, just waiting for nutritional consult and HAN setup. Since 2014, this mean waiting time exceeded 24-hours in more than half of centres. The present analysis is built based on the observation that available human resources cannot manage more HAN treatment days than done in 2014, resulting in hospital stay prolongation.

Total costs for the management of AN given the current staffing are compared with those expected after employment of extra personnel, in order to balance need and resources dedicated to HAN. Costs for hospital stay, labour and supply and delivery of HAN products and homecare services, specific for patient type, are collected and valued from the regional health service perspective.

RESULTS:

Over 848,000 HAN patient-days are expected in Piedmont for 2019. About ten more operators (physicians/dietitians) are needed to manage AN patients according to our quality standard without delaying home-based management. We estimate an annual cost saving of about € 300K, as compared with the current staffing.

CONCLUSIONS:

In order to maintain its recognized high quality level in the face of the expected quantitative increase, Piedmont network will need to increase the availability of human resources. This allocative decision would foster economic benefits.