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A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
The impact of parenteral nutrition preparation on bloodstream infection risk and costs
R S Turpin1, C Solem2, A Pontes-Arruda3
11] Department of Health Delivery Systems and Pharmacoeconomics, Takeda Pharmaceuticals, Deerfield, IL, USA [2] Department of Public Policy, Thomas Jefferson University, Philadelphia, PA, USA [3] Department of Global Health Economics and Outcomes Research/Market Access, Baxter Healthcare, Deerfield, IL, USA.
Insights
Parenteral nutrition (PN) preparation methods impact bloodstream infection (BSI) risk. Ready-to-use three-chamber bags (MCB) were associated with lower BSI risk compared to single bottles (SB), potentially reducing healthcare costs.
Area of Science:
- Clinical Pharmacy
- Infectious Diseases
- Health Economics
Background:
- Catheter-related bloodstream infections (BSIs) pose significant risks, increasing patient morbidity, hospital stay duration, and associated costs.
- Parenteral nutrition (PN) is crucial for patients unable to receive adequate nutrition orally, but its administration carries infection risks.
Purpose of the Study:
- To evaluate the risk of BSI associated with different parenteral nutrition (PN) preparation methods in Germany.
- To assess the economic impact, specifically hospitalization costs, related to various PN administration strategies.
Main Methods:
- A retrospective observational chart review was conducted on 1995 patients receiving PN between October 2009 and April 2011.
- Patients received PN via ready-to-use three-chamber bags (MCB), single bottles (SB), or hospital compounded admixtures (CPN).
- Propensity score-adjusted models analyzed the association between PN type, BSI risk (Cox Proportional Hazards), and hospitalization costs (generalized linear models).
Main Results:
- The single bottle (SB) method was linked to a significantly increased hazard of BSI compared to MCB without additions (HR: 2.53).
- Adding supplements to MCB on the ward also elevated BSI risk.
- Adjusted total costs for patients receiving all three macronutrients showed minimal differences between MCB, CPN, and SB, but MCB with ward additions was higher.
Conclusions:
- MCB use did not increase treatment costs and may reduce BSI risk.
- Certain PN preparation methods, including SB and ward additions to MCB, are associated with a higher hazard for BSI.
- Further research is needed to clarify the BSI risk associated with compounded PN, distinguishing between automated and manual methods.
Background:
Catheter-related bloodstream infections (BSIs) are a serious problem leading to increased morbidity, longer hospital stay, and hence, additional costs. This study evaluated the risk of BSI and the cost of parenteral nutrition (PN) in Germany.
Subjects/Methods:
A retrospective observational chart review of patients hospitalized from October 2009 to April 2011 and receiving PN via ready-to-use three-chamber bag (MCB), single bottle (SB) or hospital compounded admixture (CPN) was conducted across Germany. Propensity score-adjusted models were used to evaluate the association between the type of PN, BSI (Cox Proportional Hazards) and hospitalization cost (generalized linear models) within a subgroup receiving all three macronutrients (lipids, amino acids, glucose).
Results:
Of the 1995 patient records reviewed (MCB=816; CPN=584; SB=595), 1457 patients received all three macronutrients. After adjustment, SB was associated with an increased hazard of BSI, vs MCB without additions (hazard ratio (HR) (95% confidence interval (CI))=2.53 (1.66-3.86)) in the total cohort. Adding supplements to MCB on the ward also increased the BSI risk in both total and subgroup analyses. In patients receiving all three macronutrients, adjusted total costs were MCB (no additions): \[euro]6,572 (95% CI: \[euro]6,896-6263); CPN: \[euro]6,869 (\[euro]7,283-6479); SB: \[euro]6,872 (\[euro]7,242-6521); MCB (ward additions): \[euro]7,402 (\[euro]7,878-6955); P<0.001; P<0.001.
Conclusion:
Use of MCB does not appear to increase treatment costs, possibly by reducing the risk of infection. This study identified several PN preparation methods associated with a significantly increased hazard for BSI; definitive CPN findings are limited by our inability to distinguish automated from manual pharmacy compounding.
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