HEALTH CARE RESOURCES CONSUMED TO TREAT POSTOPERATIVE INFECTIONS COST SAVING BY PERIOPERATIVE IMMUNONUTRITION

The objectives of the study were to calculate the costs of postoperative complications and to evaluate whether the use of perioperative enteral immunonutrition, may lead to a saving in health care resources consumed. The economic analysis was based on data from a randomized doubleblind trial that include 206 cancer patients who received perioperatively either enteral immunonutrition treatment group, n 102 or a standard enteral diet control group, n 104. Estimates of costs were based on resource use for treatment of complications, which were valued according to the National List of Sanitary Costs of the Italian Ministry of Health and on the medical DiagnosisRelatedGroup DRG reimbursement rates. Costs of nutrition were also calculated. Cost comparison and cost effectiveness analyses were then carried out. Intenttotreat analysis showed that the total costs of 52 postoperative complications were 322,218 euros, with a consumption of the DRG reimbursement rate of 15.4. The costs of nutrition were 35,437 euros in the treatment group versus 10,768 euros in the control group. The total costs nutrition plus treating complications amounted to 113,778 euros in the treatment group versus 254,450 euros in the control group. The mean total costs per patient were 1,115 euros in the treatment group versus 2,447 euros in the control group P0.04. Effectiveness was 83.3 in the treatment group versus 68.3 in the control group P0.009. Cost effectiveness analysis showed a net saving of 2,386 euros per complicationfree patient in favor of the treatment group. In conclusion, the perioperative use of immunonutrition appears cost effective due to a substantial saving of resources used to treat postoperative complications.