Preoperative immunonutrition: Cost-benefit analysis

Background: To evaluate whether preoperative immunonutrition might lead to a savings in patient care. Data on resources consumed to treat postoperative complications are scanty, but morbidity costs continue to be a major burden for any health care system. A recent randomized clinical trial carried out in well-nourished patients with gastrointestinal cancer showed that a 5-day preoperative oral immunonutrition reduced postoperative morbidity compared with conventional treatment (no supplementation). Methods: The abovementioned trial was the basis for the economic evaluation. In-hospital related costs of routine surgical care and costs of nutrition were calculated. Estimates of complication costs were based on both resources used for treatment and additional length of hospital stay. Cost comparison and cost-effectiveness analysis were then carried out. Results: Total cost of nutrition was EURO 3407 in the conventional group and EURO 14,729 in the preoperative group. In patients without complication, the cost of in-hospital routine care was similar in both groups. The mean cost of complication was EURO 6178 in the conventional group and EURO 4639 in the preoperative group (p = .05). Total cost of patients with complications was EURO 535,236 in the conventional group and EURO 334,148 in the preoperative group. Total costs consumed 93% of the diagnosis-related-group (DRG) reimbursement rate in the conventional group and 78% in the preoperative group. Cost-effectiveness was EURO 6245 for the conventional group and EURO 2985 for the preoperative group. Conclusions: The costs of postoperative morbidity consumed a large amount of the DRG reimbursement rate. Preoperative immunonutrition was cost-effective in our series.