Cost-Consequences Analysis of Increased Utilization of Triple-Chamber-Bag Parenteral Nutrition in Preterm Neonates in Seven European Countries

Alexander Kriz, Antony Wright, Mattias Paulsson, Stephen Tomlin, Venetia Simchowitz, Thibault Senterre, Julian Shepelev, Alexander Kriz, Antony Wright, Mattias Paulsson, Stephen Tomlin, Venetia Simchowitz, Thibault Senterre, Julian Shepelev

Abstract

The safety of parenteral nutrition (PN) remains a concern in preterm neonates, impacting clinical outcomes and health-care-resource use and costs. This cost-consequence analysis assessed national-level impacts of a 10-percentage point increase in use of industry-prepared three-chamber bags (3CBs) on clinical outcomes, healthcare resources, and hospital budgets across seven European countries. A ten-percentage-point 3CB use-increase model was developed for Belgium, France, Germany, Italy, Portugal, Spain, and the UK. The cost-consequence analysis estimated the impact on compounding error harm and bloodstream infection (BSI) rates, staff time, and annual hospital budget. Of 265,000 (52%) preterm neonates, 133,000 (52%) were estimated to require PN. Baseline compounding methods were estimated as 43% pharmacy manual, 16% pharmacy automated, 22% ward, 9% outsourced, 3% industry provided non-3CBs, and 7% 3CBs. A modeled increased 3CB use would change these values to 39%, 15%, 18%, 9%, 3%, and 17%, respectively. Modeled consequences included -11.6% for harm due to compounding errors and -2.7% for BSIs. Labor time saved would equate to 41 specialized nurses, 29 senior pharmacists, 26 pharmacy assistants, and 22 senior pediatricians working full time. Budget impact would be a €8,960,601 (3.4%) fall from €260,329,814 to €251,369,212. Even a small increase in the use of 3CBs in preterm neonates could substantially improve neonatal clinical outcomes, and provide notable resource and cost savings to hospitals.

Keywords: compounding errors; cost-consequence analysis; parenteral nutrition; preterm neonates; ready-to-use three-chamber-bags.

Conflict of interest statement

A.K. is employee of Executive Insight AG. A.W. is employee of Maverex Ltd. M.P. has received honoraria from Baxter, Fresenius Kabi, and B Braun for teaching and educational activities. S.T. has received honoraria from Baxter for teaching and educational activities. V.S. has received honoraria and fees from Baxter for teaching and educational activities. T.S. and J.S. are employees of Baxter Healthcare.

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