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

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    Authors
    Webb, N
    Fricke, J
    Hancock, E
    Trueman, D
    Ghosh, S
    Winstone, J
    Miners, A
    Shepelev, J
    Valle, Juan W
    Affiliation
    Source Health Economics, Oxford, UK nwebb@source-he.com.
    Issue Date
    2020
    
    Metadata
    Show full item record
    Abstract
    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. Keywords: cancer; cost-effectiveness; malnutrition; supplemental parenteral nutrition; targeted literature review.
    Citation
    Webb N, Fricke J, Hancock E, Trueman D, Ghosh S, Winstone J, et al. The clinical and cost-effectiveness of supplemental parenteral nutrition in oncology. ESMO Open. 2020;5(3).
    Journal
    ESMO Open
    URI
    http://hdl.handle.net/10541/623094
    DOI
    10.1136/esmoopen-2020-000709
    PubMed ID
    32576610
    Additional Links
    https://dx.doi.org/10.1136/esmoopen-2020-000709
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1136/esmoopen-2020-000709
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