Pharmacoeconomic analysis of use of enteral nutrition in different clinical settings: Part 1: Use of an antiinflammatory feeding formula in critically ill patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS)

Background: The therapeutic value of enteral nutrition has been demonstrated beyond any doubt in several diseases, but such a demonstration is not so clear for specialized formulas. Comparative efficacy studies precede cost evaluation, but their design should be contemporaneous. On the other hand, an economic study can be done as a simulation of costs on important end points (i.e.) survival, length of hospital stay, and reduction of infections) obtained from a meta-analysis or randomized controlled analysis. Methods: Four hundred and eleven critically ill patients (of whom 296 were eligible) recruited in the Pontes-Arruda meta-analysis (in 2007) were analyzed to obtain a cost-effectiveness simulation. The perspective was that of the Italian National Health Service, and the comparison was made assuming Italian standard daily intensive care unit/internal medicine unit patients' costs, in a 28-day interval. Results: The simulation determined a patient cost of €23, 518 for the antiinflammatory diet (eicosapentaenoic acid + γ-linoleic acid; Oxepa Abbott) vs. €27, 645 for the control group (standard isocaloric diet), as a consequence of the different lengths of stay for these 2 groups (12.9 vs. 17.2 days). It was pointless to determine the incremental cost benefit due to the difference in the survival (0.756 vs. 0.569) because of the cost-saving situation).