- 期刊
- Ahead-of-Print
Pharmacoeconomics of parenteral nutrition in surgical and critically ill patients receiving structured triglycerides in China
摘要
Background and Objectives: A prior meta-analysis showed favorable effects of parenteral structured triglyceride (STG) lipid emulsions on metabolic outcomes in surgical and critically ill patients compared with mixed medium-chain and long-chain triglycerides (MCT/LCT) emulsions. Limited data on clinical outcomes precluded a pharmacoeconomic analysis. We performed an updated meta-analysis of studies evaluating the effect of STGs and mixed MCT/LCTs in surgical and critically ill patients and developed a cost model to compare overall costs in Chinese hospitals. Methods and Study Design: We searched Medline, Embase, Wanfang Data, the China Hospital Knowledge Database, and Google Scholar for clinical trials comparing STGs to mixed MCT/LCTs in surgical and/or critically ill adults published between October 10, 2013 and September 19, 2015. Newly identified studies were pooled with studies from the prior meta-analysis and an updated meta-analysis was performed using RevMan® version 5.3. A deterministic simulation model based on cost data from Chinese hospitals was used to compare the effects of STGs and mixed MCT/LCT's on hospital costs. Results: The systematic literature search identified six new clinical trials, resulting in a total of 27 studies that were included in the updated meta-analysis. Statistically significant differences favoring STGs were observed for cumulative nitrogen balance, prealbumin and albumin concentrations, plasma triglycerides, and liver enzymes. STGs were also associated with a significant reduction in the length of hospital stay (mean difference, -1.45 days; 95% confidence interval [CI], -2.48 to -0.43; p=0.005) compared with mixed MCT/LCTs. Cost analysis demonstrated a net cost benefit of ¥675 for STGs compared with mixed MCT/LCT emulsions. Conclusions: STGs are associated with improvements in metabolic function and reduced length of hospital stay in surgical and critically ill patients compared with mixed MCT/LCT emulsions. Cost analysis based on cost data from Chinese hospitals showed a corresponding cost benefit.
延伸閱讀
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