Updated cost-effectiveness analysis of supplemental glutamine for parenteral nutrition of intensive-care patients
Open accessAbstract
BACKGROUND/OBJECTIVES: Intravenous (i.v.) glutamine supplementation of parenteral nutrition (PN) can improve clinical outcomes, reduce mortality and infection rates and shorten the length of hospital and/or intensive care unit (ICU) stays compared with standard PN. This study is a pharmacoeconomic analysis to determine whether i.v. glutamine supplementation of PN remains both a highly favourable and cost-effective option for Italian ICU patients. SUBJECTS/METHODS: A previously published discrete event simulation model was updated by incorporating the most up-to-date and clinically relevant efficacy data (a clinically realistic subgroup analysis from a published meta-analysis), recent cost data from the Italian health-care system and the latest epidemiology data from a large Italian ICU database (covering 230 Italian ICUs and more than 77,000 patients). Sensitivity analyses were performed to test the robustness of the results. RESULTS: Parenteral glutamine supplementation can significantly improve ICU efficiency in Italy, as the additional cost of supplemented treatment is more than completely offset by cost savings in hospital care. Supplementation was more cost-effective (cost-effectiveness ratio (CER)=[euro ]35,165 per patient discharged alive) than standard, non-supplemented PN (CER=[euro ]40,156 per patient discharged alive), and it resulted in mean cost savings of [euro ]4991 per patient discharged alive or [euro ]1047 per patient admitted to the hospital. Sensitivity analyses confirmed the robustness of these results. CONCLUSIONS: Alanyl-glutamine supplementation of PN is a clinically and economically attractive strategy for ICU patients in Italy and may be applicable to selected ICU patient populations in other countries.
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Administration of combined enteral and parenteral GLN in doses higher than recommended in severely ill patients with multi-organ failure was associated with a higher mortality.
“On the other hand, the administration of combined enteral and parenteral GLN (233) in doses higher than recommended in severely ill patients with multi-organ failure was associated with a higher mortality.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [233]
The Clinical efficacy: data sources section analyzes guideline-recommended parenteral glutamine doses and reports improved survival; the Discussion says glutamine can accompany enteral or parenteral nutrition. Neither passage addresses whether above-recommended doses given by both routes increased mortality in patients with multi-organ failure. Searches for that regimen and population found no such finding in our copy. (LLM, conf=0.76)
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ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
- Authors
- Pradelli, L., Povero, M., Muscaritoli, M., & Eandi, M.
- Affiliations
- Sapienza University of Rome (IT)
- University of Turin (IT)
- Corresponding author
- Pradelli, L
- ORCID
- Venue
- European Journal of Clinical Nutrition
- Published
- 2014-12-03
- Volume
- 69
- Issue
- 5
- Pages
- 546-551
- ISSN
- 0954-3007 (ISSN-L)
- 1476-5640
- PMC
- PMC4424803
- OpenAlex
- W1978728897
- Cited by
- 22
- References
- 0
- Citations by year
- 2025: 1 · 2021: 5 · 2020: 4 · 2019: 1 · 2018: 3 · 2017: 3 · 2016: 2 · 2015: 3
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Clinical Nutrition (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- glutamine supplementation, parenteral nutrition, intensive care unit patients, cost-effectiveness, alanyl-glutamine, hospital cost savings, mortality, length of hospital stay, Italian healthcare system
- MeSH terms
- Cost-Benefit Analysis, Critical Care, Glutamine, Humans, Infections, Intensive Care Units, Italy, Length of Stay, Male, Parenteral Nutrition, Dietary Supplements
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