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EFFECTIVENESS AND COST-EFFECTIVENESS OF SUPPLEMENTAL GLUTAMINE DIPEPTIDE IN TOTAL PARENTERAL NUTRITION THERAPY FOR CRITICALLY ILL PATIENTS: A DISCRETE EVENT SIMULATION MODEL BASED ON ITALIAN DATA

Published online by Cambridge University Press:  23 January 2012

Lorenzo Pradelli
Affiliation:
Adres Health Economicsl.pradelli@adreshe.com
Sergio Iannazzo
Affiliation:
Adres Health Economics
Orietta Zaniolo
Affiliation:
Adres Health Economics
Maurizio Muscaritoli
Affiliation:
Università di Roma
Mario Eandi
Affiliation:
Università di Torino

Abstract

Introduction: The supplementation of alanyl-glutamine dipeptide in critically ill patients necessitating total parenteral nutrition (TPN) improves clinical outcomes, reducing mortality, infection rate, and shortening intensive care unit (ICU) hospital lengths of stay (LOSs), as compared to standard TPN regimens.

Methods: A Discrete Event Simulation model that incorporates outcomes rates from 200 Italian ICUs for over 60,000 patients, alanyl-glutamine dipeptide efficacy data synthesized by means of a Bayesian random effects meta-analysis, and national cost data has been developed to evaluate the alternatives from the cost perspective of the hospital. Simulated clinical outcomes are death and infection rates in ICU, death rate in general ward, and hospital LOSs. Sensitivity analyses are performed by varying all uncertain parameter values in a plausible range.

Results: The internal validation process confirmed the accuracy of the model in replicating observed clinical data. Alanyl-glutamine dipeptide on average results more effective and less costly than standard TPN: reduced mortality rate (24.6% ± 1.6% vs. 34.5% ± 2.1%), infection rate (13.8% ± 2.9% vs. 18.8% ± 3.9%), and hospital LOS (24.9 ± 0.3 vs. 26.0 ± 0.3 days) come at a lower total cost per patient (23,409 ± 3,345 vs. 24,161 ± 3,523 Euro).Treatment cost is completely offset by savings on ICU and antibiotic costs. Sensitivity analyses confirmed the robustness of these results.

Conclusions: Alanyl-glutamine dipeptide is expected to improve clinical outcomes and to do so with a concurrent saving for the Italian hospital.

Type
ASSESSMENTS
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1.Agenzia Nazionale per I Servizi Sanitari Regionali. Ricoveri, Personale e spesa delle Aziende Ospedaliere (2003). http://www.assr.it/agenas_pdf/2_Ricoveri_personale_e_spesa_aziende_ospedaliere_(2003).pdf (accessed May 2009).Google Scholar
2.Cai, G, Yan, J, Zhang, Z, Yu, Y. Immunomodulatory effects of glutamine-enriched nutritional support in elderly patients with severe sepsis: A prospective, randomized, controlled study. J Organ Dysfunct. 2008;4:3137.CrossRefGoogle Scholar
3.Canadian Clinical Practice Guidelines for Nutrition Support (2007). Critical Care Nutrition. http://www.criticalcarenutrition.com/index.php?option=com_content&task=view&id=17&Itemid=40 (accessed May 2009).Google Scholar
4.Cavallo, MC, Lazzaro, C, Tabacchi, M, et al. [Cost of ICU in Italy. Results from an empirical study on a sample of 12 hospitals]. Minerva Anestesiol. 2001;67:4153.Google Scholar
5.Dechelotte, P, Hasselmann, M, Cynober, L, et al. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: The French controlled, randomized, double-blind, multicenter study. Crit Care Med. 2006;34:598604.CrossRefGoogle ScholarPubMed
6.Duska, F, Fric, M, Waldauf, P, et al. Frequent intravenous pulses of growth hormone together with glutamine supplementation in prolonged critical illness after multiple trauma: Effects on nitrogen balance, insulin resistance, and substrate oxidation. Crit Care Med. 2008;36:17071713.CrossRefGoogle ScholarPubMed
7.Estivariz, CF, Griffith, DP, Luo, M, et al. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2008;32:389402.CrossRefGoogle ScholarPubMed
8.Fuentes-Orozco, C, Anaya-Prado, R, Gonzalez-Ojeda, A, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition improves infectious morbidity in secondary peritonitis. Clin Nutr. 2004;23:1321.CrossRefGoogle ScholarPubMed
9.Fuentes-Orozco, C, Cervantes-Guevara, G, Mucino-Hernandez, I, et al. L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis. JPEN J Parenter Enteral Nutr. 2008;32:403411.Google ScholarPubMed
10.Goeters, C, Wenn, A, Mertes, N, et al. Parenteral L-alanyl-L-glutamine improves 6-month outcome in critically ill patients. Crit Care Med. 2002;30:20322037.CrossRefGoogle ScholarPubMed
11.Griffiths, RD, Jones, C, Palmer, TE. Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition. Nutrition. 1997;13:295302.Google ScholarPubMed
12.Informatore Farmaceutico – 69a edizione. Milano: Ed. Elsevier Masson; 2009.Google Scholar
13.Luo, M, Bazargan, N, Griffith, DP, et al. Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: A pilot study. Clin Nutr. 2008;27:297306.CrossRefGoogle ScholarPubMed
14.Novak, F, Heyland, DK, Avenell, A, Drover, JW, Su, X. Glutamine supplementation in serious illness: A systematic review of the evidence. Crit Care Med. 2002;30:20222029.CrossRefGoogle Scholar
15.Orsi, GB, Di Stefano, L, Noah, N. Hospital-acquired, laboratory-confirmed bloodstream infection: Increased hospital stay and direct costs. Infect Control Hosp Epidemiol. 2002;23:190197.Google ScholarPubMed
16.Oudemans-van Straaten, H, Bosman, R, Treskes, M, van der Spoel, H, Zandstra, D. Plasma glutamine depletion and patient outcome in acute ICU admissions. Intensive Care Med. 2001;27:8490.CrossRefGoogle ScholarPubMed
17.Pérez-Bárcena, J, Regueiro, V, Marsé, P, et al. Glutamine as a modulator of the immune system of critical care patients: Effect on toll-like receptor expression. A preliminary study. Nutrition. 2008;24:522527.CrossRefGoogle ScholarPubMed
18.Powell-Tuck, J, Jamieson, CP, Bettany, GE, et al. A double blind, randomised, controlled trial of glutamine supplementation in parenteral nutrition. Gut. 1999;45:8288.CrossRefGoogle ScholarPubMed
19.Progetto MARGHERITA – Rapporto 2007. Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (GIVITI). Sestante Edizioni – Bergamo, 2008Google Scholar
20.Sahin, H, Mercanligil, SM, Inanç, N, Ok, E. Effects of glutamine-enriched total parenteral nutrition on acute pancreatitis. Eur J Clin Nutr. 2007;61:14291434.CrossRefGoogle ScholarPubMed
21.Spiegelhalter, D, Abrams, K, Myles, J. Bayesian approaches to clinical trials and health-care evaluation. New York: Wiley-Blackwell; 2003.CrossRefGoogle Scholar
22.Wessner, B, Strasser, E, Spittler, A, Roth, E. Effect of single and combined supply of glutamine, glycine, N-acetylcysteine, and R,S-alpha-lipoic acid on glutathione content of myelomonocytic cells. Clin Nutr. 2003;22:515522.CrossRefGoogle Scholar
23.Wischmeyer, PE, Lynch, J, Liedel, J, et al. Glutamine administration reduces Gram-negative bacteremia in severely burned patients: A prospective, randomized, double-blind trial versus isonitrogenous control. Crit Care Med. 2001;29:20752080.CrossRefGoogle ScholarPubMed
24.Xian-Li, H, Qing-Jiu, M, Jian-Guo, L, Yan-Kui, C, Xi-Lin, D. Effect of total parenteral nutrition (TPN) with and without glutamine dipeptide supplementation on outcome in severe acute pancreatitis (SAP). Clin Nutr. 2004;(Suppl 1):4347.Google Scholar
25.Zhou, Y-P, Jiang, Z-M, Sun, Y-H, He, G-Z, Shu, H. The effects of supplemental glutamine dipeptide on gut integrity and clinical outcome after major escharectomy in severe burns: A randomized, double-blind, controlled clinical trial. Clin Nutr Suppl. 2004;1:5560.CrossRefGoogle Scholar
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EFFECTIVENESS AND COST-EFFECTIVENESS OF SUPPLEMENTAL GLUTAMINE DIPEPTIDE IN TOTAL PARENTERAL NUTRITION THERAPY FOR CRITICALLY ILL PATIENTS: A DISCRETE EVENT SIMULATION MODEL BASED ON ITALIAN DATA
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EFFECTIVENESS AND COST-EFFECTIVENESS OF SUPPLEMENTAL GLUTAMINE DIPEPTIDE IN TOTAL PARENTERAL NUTRITION THERAPY FOR CRITICALLY ILL PATIENTS: A DISCRETE EVENT SIMULATION MODEL BASED ON ITALIAN DATA
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EFFECTIVENESS AND COST-EFFECTIVENESS OF SUPPLEMENTAL GLUTAMINE DIPEPTIDE IN TOTAL PARENTERAL NUTRITION THERAPY FOR CRITICALLY ILL PATIENTS: A DISCRETE EVENT SIMULATION MODEL BASED ON ITALIAN DATA
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