Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis
Abstract Background Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions. Here, we evaluate the impact of ω-3 FA-containing PN versus standard PN on clinica...
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doaj-a37dd0fa1d054e6a8c6e7d9c3c44d3552020-11-25T04:06:52ZengBMCCritical Care1364-85352020-11-0124111210.1186/s13054-020-03356-wOmega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysisLorenzo Pradelli0Stanislaw Klek1Konstantin Mayer2Abdul Jabbar Omar Alsaleh3Martin D. Rosenthal4Axel R. Heller5Maurizio Muscaritoli6AdRes-Health Economics and Outcome ResearchDepartment of General and Oncology Surgery With Intestinal Failure Unit, Stanley Dudrick’s Memorial HospitalMedical Clinic 4, Pneumology and Sleep Medicine, ViDia Hospitals KarlsruheDepartment of Economics, University of BolognaDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Florida College of MedicineDepartment of Anesthesiology and Intensive Care Medicine, University of AugsburgDepartment of Clinical Medicine, Sapienza University of RomeAbstract Background Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions. Here, we evaluate the impact of ω-3 FA-containing PN versus standard PN on clinical outcomes and costs in adult intensive care unit (ICU) patients using a meta-analysis and subsequent cost-effectiveness analysis from the perspective of a hospital operating in five European countries (France, Germany, Italy, Spain, UK) and the US. Methods We present a pharmacoeconomic simulation based on a systematic literature review with meta-analysis. Clinical outcomes and costs comparing ω-3 FA-containing PN with standard PN were evaluated in adult ICU patients eligible to receive PN covering at least 70% of their total energy requirements and in the subgroup of critically ill ICU patients (mean ICU stay > 48 h). The meta-analysis with the co-primary outcomes of infection rate and mortality rate was based on randomized controlled trial data retrieved via a systematic literature review; resulting efficacy data were subsequently employed in country-specific cost-effectiveness analyses. Results In adult ICU patients, ω-3 FA-containing PN versus standard PN was associated with significant reductions in the relative risk (RR) of infection (RR 0.62; 95% CI 0.45, 0.86; p = 0.004), hospital length of stay (HLOS) (− 3.05 days; 95% CI − 5.03, − 1.07; p = 0.003) and ICU length of stay (LOS) (− 1.89 days; 95% CI − 3.33, − 0.45; p = 0.01). In critically ill ICU patients, ω-3 FA-containing PN was associated with similar reductions in infection rates (RR 0.65; 95% CI 0.46, 0.94; p = 0.02), HLOS (− 3.98 days; 95% CI − 6.90, − 1.06; p = 0.008) and ICU LOS (− 2.14 days; 95% CI − 3.89, − 0.40; p = 0.02). Overall hospital episode costs were reduced in all six countries using ω-3 FA-containing PN compared to standard PN, ranging from €-3156 ± 1404 in Spain to €-9586 ± 4157 in the US. Conclusion These analyses demonstrate that ω-3 FA-containing PN is associated with statistically and clinically significant improvement in patient outcomes. Its use is also predicted to yield cost savings compared to standard PN, rendering ω-3 FA-containing PN an attractive cost-saving alternative across different health care systems. Study registration PROSPERO CRD42019129311.http://link.springer.com/article/10.1186/s13054-020-03356-wParenteral nutritionIntensive careCritically illMeta-analysisCost-effectivenessOmega-3 fatty acid |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lorenzo Pradelli Stanislaw Klek Konstantin Mayer Abdul Jabbar Omar Alsaleh Martin D. Rosenthal Axel R. Heller Maurizio Muscaritoli |
spellingShingle |
Lorenzo Pradelli Stanislaw Klek Konstantin Mayer Abdul Jabbar Omar Alsaleh Martin D. Rosenthal Axel R. Heller Maurizio Muscaritoli Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis Critical Care Parenteral nutrition Intensive care Critically ill Meta-analysis Cost-effectiveness Omega-3 fatty acid |
author_facet |
Lorenzo Pradelli Stanislaw Klek Konstantin Mayer Abdul Jabbar Omar Alsaleh Martin D. Rosenthal Axel R. Heller Maurizio Muscaritoli |
author_sort |
Lorenzo Pradelli |
title |
Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis |
title_short |
Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis |
title_full |
Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis |
title_fullStr |
Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis |
title_full_unstemmed |
Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis |
title_sort |
omega-3 fatty acid-containing parenteral nutrition in icu patients: systematic review with meta-analysis and cost-effectiveness analysis |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2020-11-01 |
description |
Abstract Background Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions. Here, we evaluate the impact of ω-3 FA-containing PN versus standard PN on clinical outcomes and costs in adult intensive care unit (ICU) patients using a meta-analysis and subsequent cost-effectiveness analysis from the perspective of a hospital operating in five European countries (France, Germany, Italy, Spain, UK) and the US. Methods We present a pharmacoeconomic simulation based on a systematic literature review with meta-analysis. Clinical outcomes and costs comparing ω-3 FA-containing PN with standard PN were evaluated in adult ICU patients eligible to receive PN covering at least 70% of their total energy requirements and in the subgroup of critically ill ICU patients (mean ICU stay > 48 h). The meta-analysis with the co-primary outcomes of infection rate and mortality rate was based on randomized controlled trial data retrieved via a systematic literature review; resulting efficacy data were subsequently employed in country-specific cost-effectiveness analyses. Results In adult ICU patients, ω-3 FA-containing PN versus standard PN was associated with significant reductions in the relative risk (RR) of infection (RR 0.62; 95% CI 0.45, 0.86; p = 0.004), hospital length of stay (HLOS) (− 3.05 days; 95% CI − 5.03, − 1.07; p = 0.003) and ICU length of stay (LOS) (− 1.89 days; 95% CI − 3.33, − 0.45; p = 0.01). In critically ill ICU patients, ω-3 FA-containing PN was associated with similar reductions in infection rates (RR 0.65; 95% CI 0.46, 0.94; p = 0.02), HLOS (− 3.98 days; 95% CI − 6.90, − 1.06; p = 0.008) and ICU LOS (− 2.14 days; 95% CI − 3.89, − 0.40; p = 0.02). Overall hospital episode costs were reduced in all six countries using ω-3 FA-containing PN compared to standard PN, ranging from €-3156 ± 1404 in Spain to €-9586 ± 4157 in the US. Conclusion These analyses demonstrate that ω-3 FA-containing PN is associated with statistically and clinically significant improvement in patient outcomes. Its use is also predicted to yield cost savings compared to standard PN, rendering ω-3 FA-containing PN an attractive cost-saving alternative across different health care systems. Study registration PROSPERO CRD42019129311. |
topic |
Parenteral nutrition Intensive care Critically ill Meta-analysis Cost-effectiveness Omega-3 fatty acid |
url |
http://link.springer.com/article/10.1186/s13054-020-03356-w |
work_keys_str_mv |
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