TableA.9 Cost effectiveness of GI services: summary of articles examined for home parenteral nutrition

AuthorsResearch setting and year of studyStudy designSample sizeTopic of documentResults and conclusionsComments
Richards et al760NA (1980–85)Systematic reviewNAWhat evidence exists for the cost effectiveness of HPN?What questions could be answered with additional research?Two cost utility analyses (CUAs) were identified (one in Canada and one in the UK). The marginal cost per QALY varied from Canadian $14 600 to UK £69 000. The most recent estimate of cost to the NHS was £45 000 for the first year and £36 000 for subsequent years. The studies showed that HPN was 65–80% cheaper than the alternative hospital treatment. However, patients and community costs were not measured.There are no economic evaluations of HPN for malignant disease and AIDSPatient referral patterns for HPN treatment are inconsistent; some regions in the UK have very few patients receiving HPN. However, there are several large centres in the UK where HPN is considered as an essential, life-saving treatment.What methodological issues need to be dealt with in future:1. Up-to-date registries 2. A more in-depth description of episodes of care should be in place 3. patient long term monitoring should be laid down 4. Large multicentre RCTs should be carried out to evaluate alternative models of care
Puntis761UK (1998)Literature reviewNACost-utility appraisal of HPNThe effectiveness of HPN is about 65% greater than hospital careThis article reviewed most of the articles included in the previous article760