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PTU-116 The switch from bespoke parenteral nutrition to off-the-shelf bags may not be cost effective: experience from a dgh nutrition support team
  1. D Lloyd1,
  2. C Best2,
  3. J Summers2,
  4. H Gordon1
  1. 1Department of Gastroenterology
  2. 2Department of Nutrition and Dietetics, Royal Hampshire County Hospital, Winchester, UK


Introduction Bespoke parenteral nutrition (PN) is considered the gold standard as it can be tailored to patient need. However, in-house PN formulation requires aseptic facilities and is therefore considered expensive and labour intensive. Commercially available off-the-shelf (OTS) PN avoids the need for an aseptic unit but PN bags have fixed formulations and limited lifespan. Our hospital switched from bespoke PN to using predominantly OTS PN in 2014. The OTS bags expire 1 month after manufacture. Since 2014 bespoke PN has been ordered in from a commercial supplier as required. The aim of this study was to compare the cost of PN before and after the switch.

Method PN usage and cost is monitored annually by the Nutrition Support Team (NST). Data on PN prescribing, supply and wastage were obtained from the NST database and from electronic Pharmacy records over a 5 year period from April 2011 to April 2016 and data for the 2 financial years prior to the switch to OTS PN were compared to data for the 2 years after the switch. Prior to the switch to OTS PN, the cost of formulating PN on site was calculated from Pharmacy data based on the cost of PN and additives coupled with an estimation of the cost of compounding. After the switch to OTS PN, the cost of both OTS PN and bespoke bags were obtained directly from Pharmacy records.

Results Annual PN usage, wastage and cost for the two years before and after the switch to OTS PN are shown in Table 1. Over the two years following the switch to OTS PN, 89% of PN bags used were OTS and 11% were bespoke. PN wastage occurred either due to PN being discarded on the ward or due to expiry of OTS PN bags. The average estimated cost of PN made in-house prior to the switch to OTS PN was £60 per bag. Cost of OTS PN bags ranged from £45 to £51. The average cost of bespoke PN (including delivery costs) was £150.

Abstract PTU-116 Table 1

Conclusion Contrary to expectation, the switch from bespoke PN to OTS PN resulted in a slight increase in the overall cost of PN due to increased wastage of PN and the increased cost of buying in bespoke PN when required.

Disclosure of Interest None Declared

  • Bespoke
  • Cost
  • Off-the-shelf
  • Parenteral Nutrition

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