The clinical and cost-effectiveness of supplemental parenteral nutrition in oncology

© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology..

BACKGROUND: Clinical guidelines recommend that parenteral nutrition (PN) is added to enteral nutrition (EN; supplemental parenteral nutrition (SPN)) in order to meet energy and protein needs in patients with cancer when EN alone is insufficient. However, although cancer-related malnutrition is common, there is poor awareness of the value of nutritional care, resulting in SPN being chronically underused.

METHODS: We performed a targeted literature review and exploratory cost-utility analysis to gather evidence on the clinical effectiveness of SPN, and to estimate the potential cost-effectiveness of SPN versus EN alone in an example cancer setting.

RESULTS: The literature review identified studies linking SPN with malnutrition markers, and studies linking malnutrition markers with clinical outcomes. SPN was linked to improvements in body mass index (BMI), fat-free mass, phase angle (PhA) and prealbumin. Of these markers, BMI and PhA were strong predictors of survival. By combining published data, we generated indirect estimates of the overall survival HR associated with SPN; these ranged from 0.80 to 0.99 (mode 0.87). In patients with Stage IV inoperable pancreatic cancer, the incremental cost-effectiveness ratio versus EN alone was estimated to be £41 350 or £91 501 depending on whether nursing and home delivery costs for EN and SPN were combined or provided separately.

CONCLUSION: Despite a lack of direct evidence, the results of the literature review demonstrate that SPN may provide important clinical and quality of life benefits to patients with cancer. The potential for any improvement in outcomes in the modelled patient population is very limited, so cost-effectiveness may be greater in patients with less severe disease and other types of cancer.

Errataetall:

CommentIn: ESMO Open. 2020 Jul;5(4):. - PMID 32661187

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:5

Enthalten in:

ESMO open - 5(2020), 3 vom: 23. Juni, Seite e000709

Sprache:

Englisch

Beteiligte Personen:

Webb, Neil [VerfasserIn]
Fricke, Julie [VerfasserIn]
Hancock, Elizabeth [VerfasserIn]
Trueman, David [VerfasserIn]
Ghosh, Srobana [VerfasserIn]
Winstone, Julie [VerfasserIn]
Miners, Alec [VerfasserIn]
Shepelev, Julian [VerfasserIn]
Valle, Juan W [VerfasserIn]

Links:

Volltext

Themen:

Cancer
Cost-effectiveness
Journal Article
Malnutrition
Research Support, Non-U.S. Gov't
Review
Supplemental parenteral nutrition
Targeted literature review

Anmerkungen:

Date Completed 19.07.2021

Date Revised 19.07.2021

published: Print

CommentIn: ESMO Open. 2020 Jul;5(4):. - PMID 32661187

Citation Status MEDLINE

doi:

10.1136/esmoopen-2020-000709

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM311550851