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Frau T, El Khatib M, De Dreuille B, Billiauws L, Nuzzo A, Joly F. Emerging drugs for the treatment of short bowel syndrome. Expert Opin Emerg Drugs 2024:1-12. [PMID: 38761162 DOI: 10.1080/14728214.2024.2357567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/16/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION SBS is a rare and disabling condition. The standard management is based on diet optimization with parenteral supplementation. In addition, glucagon-like peptide-2 (GLP-2)analogs, have shown promising results as disease-modifying therapies for SBS. AREAS COVERED Short bowel syndrome (SBS) is defined as a reduction in functional intestinal length to less than 200 cm, leading to intestinal failure (IF) leading to malnutrition and parenteral support dependency. This review discusses the current management of SBS-CIFpatients, the place of GLP-2 analog treatment in terms of efficacy, safety and availability, and the new perspectives opened by the use of enterohormones. EXPERT OPINION Clinical trials and real-world experience demonstrated that Teduglutide reduces dependence on parenteral support and has a place in the management of patients with SBS-CIF. The use of Teduglutide should be discussed in patients stabilized after resection and its introduction requires the advice of an expert center capable of assessing the benefit-risk ratio. The complex, individualized management of SBS-C IF requires theexpertise of a specialized IF center which a multidisciplinary approach. The arrival of new treatments will call for new therapeutic strategies, and the question of how to introduce and monitor them will represent a new therapeutic challenge.
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Affiliation(s)
- Tristan Frau
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
| | - Myriam El Khatib
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
| | - Brune De Dreuille
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot Paris, France
| | - Lore Billiauws
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot Paris, France
| | - Alexandre Nuzzo
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Hôpital Bichat, Laboratory for Vascular Translational Science, Paris, France
| | - Francisca Joly
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot Paris, France
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2
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Sarofim M, Ahmadi N, Morris DL. Shifting the paradigm of long-term total parenteral nutrition: Lessons from renal dialysis. JPEN J Parenter Enteral Nutr 2024; 48:372-374. [PMID: 38297819 DOI: 10.1002/jpen.2602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Affiliation(s)
- Mina Sarofim
- Liver and Peritonectomy Unit, St George Hospital, Kogarah, New South Wales, Australia
- St George and Sutherland School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Camperdown, New South Wales, Australia
| | - Nima Ahmadi
- Liver and Peritonectomy Unit, St George Hospital, Kogarah, New South Wales, Australia
- St George and Sutherland School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - David L Morris
- Liver and Peritonectomy Unit, St George Hospital, Kogarah, New South Wales, Australia
- St George and Sutherland School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Xu W, Williams L, Sebaratnam G, Varghese C, Cedarwall C, Daker C, Keane C. Gastric Alimetry® Testing and Healthcare Economic Analysis in Nausea and Vomiting Syndromes. Dig Dis Sci 2024:10.1007/s10620-024-08455-0. [PMID: 38689198 DOI: 10.1007/s10620-024-08455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Chronic nausea and vomiting syndromes (CNVS), gastroparesis and functional dyspepsia (FD) are complex disorders. Body Surface Gastric Mapping (BSGM), a new test of gastric function, using Gastric Alimetry® (Alimetry, New Zealand) may be useful for de-escalating healthcare utilisation. This study aimed to define healthcare costs and estimate health economic impacts of implementing this test in patients with chronic gastroduodenal symptoms. METHODS Consecutive patients at a tertiary referral centre evaluated with Gastric Alimetry were included. Frequency and cost data relating to medical investigations, hospital and outpatient presentations were evaluated. Costs of healthcare utilisation were calculated, and the potential cost savings of implementing Gastric Alimetry within a diagnostic decision-tree model were estimated. RESULTS Overall, 31 consecutive patients (mean age 36.1 years; 83.9% female; predominant symptoms: nausea [83.9%], pain [61.3%], vomiting [67.7%] and bloating [35.5%]) completed Gastric Alimetry testing. Repeat gastroscopy and abdominal CT rates were 29% (8/28) and 85% (11/13), respectively. Gastric Alimetry testing identified spectral abnormalities in 45.2% of patients, and symptom profiling classified a further 29.1% of patients. Median annualised cost difference after test introduction was NZ$-12,032. Estimated reductions in investigation-related costs when incorporating Gastric Alimetry into the diagnostic workflow model were approximately NZ$1,300 per patient. CONCLUSIONS Healthcare utilisation and confirmatory testing rates remain high in nausea and vomiting syndromes. This study presents real-world data, together with a decision-tree analysis, showing Gastric Alimetry can streamline clinical care pathways, resulting in reduced healthcare utilisation and cost.
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Affiliation(s)
- William Xu
- The University of Auckland, Auckland, New Zealand
- Te Tai Tokerau District, Te Whatu Ora, Whangarei, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | | | - Chris Varghese
- The University of Auckland, Auckland, New Zealand
- Counties Manukau District, Te Whatu Ora, Whangarei, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Chris Cedarwall
- Capital and Coast District, Te Whatu Ora, Whangarei, New Zealand
| | | | - Celia Keane
- Te Tai Tokerau District, Te Whatu Ora, Whangarei, New Zealand.
- Department of Surgery, University of Auckland, Auckland, New Zealand.
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Williams TJ, Moy N, Kaazan P, Callaghan G, Holtmann G, Martin N. Cost-effectiveness of taurolidine-citrate in a cohort of patients with intestinal failure receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr 2024; 48:165-173. [PMID: 38062902 DOI: 10.1002/jpen.2589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 10/05/2023] [Accepted: 12/05/2023] [Indexed: 01/02/2024]
Abstract
BACKGROUND Catheter-related bloodstream infections (CRBSIs) in patients receiving home parenteral nutrition (HPN) for chronic intestinal failure (CIF) are associated with significant morbidity and financial costs. Taurolidine is associated with a reduction in bloodstream infections, with limited information on the cost-effectiveness as the primary prevention. This study aimed to determine the cost-effectiveness of using taurolidine-citrate for the primary prevention of CRBSIs within a quaternary hospital. METHODS All patients with CIF receiving HPN were identified between January 2015 and November 2022. Data were retrospectively collected regarding patient demographics, HPN use, CRBSI diagnosis, and use of taurolidine-citrate. The direct costs associated with CRBSI-associated admissions and taurolidine-citrate use were obtained from the coding department using a bottom-up approach. An incremental cost-effective analysis was performed, with a time horizon of 4 years, to compare the costs associated with primary and secondary prevention against the outcome of cost per infection avoided. RESULTS Forty-four patients received HPN within this period. The CRBSI rates were 3.25 infections per 1000 catheter days before the use of taurolidine-citrate and 0.35 infections per 1000 catheter days after taurolidine-citrate use. The incremental cost-effectiveness ratio indicates primary prevention is the weakly dominant intervention, with the base case value of $27.04 per CRBSI avoided. This held with one-way sensitivity analysis. CONCLUSION Taurolidine-citrate in the primary prevention of CRBSIs in patients with CIF receiving HPN is associated with reduced hospital costs and infection rates.
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Affiliation(s)
- Thomas J Williams
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Naomi Moy
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Patricia Kaazan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Gavin Callaghan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Neal Martin
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
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Cucinotta U, Acunzo M, Payen E, Talbotec C, Chasport C, Alibrandi A, Lacaille F, Lambe C. The Impact of Teduglutide on Real-Life Health Care Costs in Children with Short Bowel Syndrome. J Pediatr 2023; 272:113882. [PMID: 38135030 DOI: 10.1016/j.jpeds.2023.113882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To analyze the real-life health care costs of home parenteral nutrition (HPN) in children with short bowel syndrome with intestinal failure (SBS-IF) before and after treatment with teduglutide, and to compare those with costs of children with SBS-IF not treated with teduglutide. STUDY DESIGN All consecutive children with SBS-IF on HPN treated with subcutaneous teduglutide starting from 2018 through 2020 in a tertiary French referral center were retrospectively included. These patients were matched to children with SBS-IF on HPN followed during the same 3-year period who were eligible for the teduglutide but were not treated. HPN direct medical costs included home-care charges, HPN bags, hospital admissions, and teduglutide. A comparison of costs before/after treatment and between patients treated/not treated was performed. RESULTS Sixty children were included: 30 (50%) were treated with teduglutide and 30 (50%) were untreated. In the treated group, the median total costs of HPN significantly decreased after 1 (P < .001) and 2 years of treatment (P < .001) from 59 454 euros/year/patient to 43 885 euros/year/patient and 34 973 euros/year/patient, respectively. When we compared patients treated and not treated, the total HPN costs/year/patient were similar at baseline (P = .6) but were significantly lower in the teduglutide-treated group after 1 (P = .006) and 2 years of treatment (P < .001). When we added the cost of teduglutide into the analysis, the total cost increased significantly in the treated group and remained much greater even after modeling a reduction in the cost of the drug to one-third the present cost and PN weaning (P < .001). CONCLUSIONS Treatment with teduglutide is associated with a significant reduction in the annual costs of HPN but still remains expensive because of the drug itself. Finding cost-saving strategies is essential.
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Affiliation(s)
- Ugo Cucinotta
- Pediatric Gastroenterology and Nutrition, Necker Enfants Malades University Hospital, Paris, France; Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
| | - Miriam Acunzo
- Pediatric Gastroenterology and Nutrition, Necker Enfants Malades University Hospital, Paris, France; Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Elise Payen
- Pediatric Gastroenterology and Nutrition, Necker Enfants Malades University Hospital, Paris, France
| | - Cécile Talbotec
- Pediatric Gastroenterology and Nutrition, Necker Enfants Malades University Hospital, Paris, France
| | - Céline Chasport
- Pharmacy, Hopital Universitaire Necker-Enfants Malades, Paris, France
| | - Angela Alibrandi
- Statistical and Mathematical Science Unit, Department of Economics, University of Messina, Messina, Italy
| | - Florence Lacaille
- Pediatric Gastroenterology and Nutrition, Necker Enfants Malades University Hospital, Paris, France
| | - Cécile Lambe
- Pediatric Gastroenterology and Nutrition, Necker Enfants Malades University Hospital, Paris, France
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Pironi L, Cuerda C, Jeppesen PB, Joly F, Jonkers C, Krznarić Ž, Lal S, Lamprecht G, Lichota M, Mundi MS, Schneider SM, Szczepanek K, Van Gossum A, Wanten G, Wheatley C, Weimann A. ESPEN guideline on chronic intestinal failure in adults - Update 2023. Clin Nutr 2023; 42:1940-2021. [PMID: 37639741 DOI: 10.1016/j.clnu.2023.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND & AIMS In 2016, ESPEN published the guideline for Chronic Intestinal Failure (CIF) in adults. An updated version of ESPEN guidelines on CIF due to benign disease in adults was devised in order to incorporate new evidence since the publication of the previous ESPEN guidelines. METHODS The grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used to grade the literature. Recommendations were graded according to the levels of evidence available as A (strong), B (conditional), 0 (weak) and Good practice points (GPP). The recommendations of the 2016 guideline (graded using the GRADE system) which were still valid, because no studies supporting an update were retrieved, were reworded and re-graded accordingly. RESULTS The recommendations of the 2016 guideline were reviewed, particularly focusing on definitions, and new chapters were included to devise recommendations on IF centers, chronic enterocutaneous fistulas, costs of IF, caring for CIF patients during pregnancy, transition of patients from pediatric to adult centers. The new guideline consist of 149 recommendations and 16 statements which were voted for consensus by ESPEN members, online in July 2022 and at conference during the annual Congress in September 2022. The Grade of recommendation is GPP for 96 (64.4%) of the recommendations, 0 for 29 (19.5%), B for 19 (12.7%), and A for only five (3.4%). The grade of consensus is "strong consensus" for 148 (99.3%) and "consensus" for one (0.7%) recommendation. The grade of consensus for the statements is "strong consensus" for 14 (87.5%) and "consensus" for two (12.5%). CONCLUSIONS It is confirmed that CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for the underlying gastrointestinal disease and to provide HPN support. Most of the recommendations were graded as GPP, but almost all received a strong consensus.
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Affiliation(s)
- Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Francisca Joly
- Center for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Cora Jonkers
- Nutrition Support Team, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Željko Krznarić
- Center of Clinical Nutrition, Department of Medicine, University Hospital Center, Zagreb, Croatia
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | | | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
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Jiang T, Cai Z, Mu M, Zhao Z, Shen C, Zhang B. The Global Burden of Vascular Intestinal Disorders in 204 Countries and Territories From 1990 to 2019: Global Burden of Diseases Study. Int J Public Health 2023; 68:1606297. [PMID: 37822566 PMCID: PMC10562586 DOI: 10.3389/ijph.2023.1606297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/21/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives: Assess the prevalence, mortality, and disability-adjusted life years (DALYs) of vascular intestinal disorders (VID) from 1990 to 2019. Methods: This study conducted a secondary data analysis utilizing the Global Burden of Diseases Study 2019. The prevalence, mortality and DALYs of VID were analyzed by sex, age and socio-demographic index (SDI), respectively. Analyses were performed by using R software. Results: Globally, the number of prevalent VID cases increased from 100,158 (95% uncertainty interval: 89,428-114,013) in 1,990-175,740 (157,941-198,969) in 2019. However, the age-standardized rates (ASR) of VID prevalence declined from 2.47 (95% uncertainty interval: 2.24-2.76) per 100,000 population to 2.21 (1.98-2.48) per 100,000 population between 1990 and 2019. Furthermore, the ASR of mortality also decreased from 1990 to 2019. Between 1990 and 2019, the regions with high and high-middle level exhibited the highest diseases burden. Conclusion: Globally, the diseases burden associated with VID demonstrated a decline from 1990 to 2019. However, concerted efforts are still required to enhance measures to combat VID within countries categorized as high and high-middle SDI.
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Affiliation(s)
- Tianxiang Jiang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mingchun Mu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Zhao
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Chaoyong Shen
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Winkler M, Tappenden K. Epidemiology, survival, costs, and quality of life in adults with short bowel syndrome. Nutr Clin Pract 2023; 38 Suppl 1:S17-S26. [PMID: 37115027 DOI: 10.1002/ncp.10964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 04/29/2023] Open
Abstract
Short bowel syndrome (SBS) is a rare disorder with known physical, psychosocial, and economic burdens and significant morbidity and mortality. Many individuals with SBS require long-term home parenteral nutrition (HPN). The incidence and prevalence of SBS is difficult to determine because it is often based on HPN usage and may not account for those who receive intravenous fluids or achieve enteral autonomy. The most common etiologies associated with SBS are Crohn's disease and mesenteric ischemia. Intestinal anatomy and remnant bowel length are prognostic for HPN dependency, and enteral autonomy confers a survival advantage. Health economic data confirm that PN-related costs are higher for hospitalizations than at home; yet significant healthcare resource utilization is necessary for successful HPN, and patients and families report substantial financial distress that impacts quality of life (QOL). An important advancement in QOL measurement is the validation of HPN- and SBS-specific QOL questionnaires. In addition to the known factors negatively impacting QOL, such as diarrhea, pain, nocturia, fatigue, depression, and narcotic dependency, research has shown that the volume and number of PN infusions per week is associated with QOL. Although traditional QOL measurements describe how underlying disease and therapy influence life, they do not assess how symptoms and functional limitations affect the QOL of patients and caregivers. Patient-centered measures and conversation focused on psychosocial issues helps patients with SBS and HPN dependency better cope with their disease and treatment. This article presents a brief overview of SBS, including epidemiology, survival, costs, and QOL.
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Affiliation(s)
- Marion Winkler
- Department of Surgery/Nutrition Support, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kelly Tappenden
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
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Gompelman M, Wezendonk GTJ, Wouters Y, Beurskens-Meijerink J, Fragkos KC, Rahman FZ, Coolen JPM, van Weerdenburg IJM, Wertheim HFL, Kievit W, Akkermans RP, Serlie MJ, Bleeker-Rovers CP, Wanten GJA. Randomized clinical trial: Long-term Staphylococcus aureus decolonization in patients on home parenteral nutrition. Clin Nutr 2023; 42:706-716. [PMID: 36965196 DOI: 10.1016/j.clnu.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/01/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND & AIMS Staphylococcus aureus decolonization has proven successful in prevention of S. aureus infections and is a key strategy to maintain venous access and avoid hospitalization in patients receiving home parenteral nutrition (HPN). We aimed to determine the most effective and safe long-term S. aureus decolonization regimen. METHODS A randomized, open-label, multicenter clinical trial was conducted. Adult intestinal failure patients with HPN support and carrying S. aureus were randomly assigned to a 'continuous suppression' (CS) strategy, a repeated chronic topical antibiotic treatment or a 'search and destroy' (SD) strategy, a short and systemic antibiotic treatment. Primary outcome was the proportion of patients in whom S. aureus was totally eradicated during a 1-year period. Secondary outcomes included risk factors for decolonization failure and S. aureus infections, antimicrobial resistance, adverse events, patient compliance and cost-effectivity. RESULTS 63 participants were included (CS 31; SD 32). The mean 1-year S. aureus decolonization rate was 61% (95% CI 44, 75) for the CS group and 39% (95% CI 25, 56) for the SD group with an OR of 2.38 (95% CI 0.92, 6.11, P = 0.07). More adverse effects occurred in the SD group (P = 0.01). Predictors for eradication failure were a S. aureus positive caregiver and presence of a (gastro)enterostomy. CONCLUSION We did not demonstrate an increased efficacy of a short and systemic S. aureus decolonization strategy over a continuous topical suppression treatment. The latter may be the best option for HPN patients as it achieved a higher long-term decolonization rate and was well-tolerated (NCT03173053).
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Affiliation(s)
- Michelle Gompelman
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Guus T J Wezendonk
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yannick Wouters
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Judith Beurskens-Meijerink
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Konstantinos C Fragkos
- Intestinal Failure Service, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farooq Z Rahman
- Intestinal Failure Service, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jordy P M Coolen
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid J M van Weerdenburg
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Heiman F L Wertheim
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Reinier P Akkermans
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geert J A Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
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10
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Rothkopf M, Pant M, Brown R, Haselhorst J, Gagliardotto F, Tallman A, Stevenson D, DePalma A, Saracco M, Rosenberg D, Proudan V, Shareef K, Ayub N. Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition. BMJ Nutr Prev Health 2022; 5:286-296. [PMID: 36619321 PMCID: PMC9813622 DOI: 10.1136/bmjnph-2022-000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Home parenteral nutrition (HPN) is essential for patients with intestinal failure requiring long-term nutritional support. The Amerita Quality Improvement Project for HPN Patients (QIP-PN) explored the effect of a physician nutrition expert (PNE)-led multidisciplinary nutritional support team (MNST) on HPN care for patients under its service. Objective To determine an MNST effect on adherence to protocols, outcomes and quality of life (QOL) in HPN. Methods The study was divided into three phases: data review (phases 1a and 1b), observation (phase 2) and intervention (phase 3). Seven Amerita locations were selected as 'study branches' (population), from which all study patients and controls were drawn. The quality improvement project employed a quasi-experimental case-matched control group (control) design. Data were collected on demographics, treating physicians PNE status, HPN care variables, recommended interventions, quality-of-life assessment, adverse outcomes and hospitalisations. Paired t-test compared continuous data between phases 2 and 3. Comparisons between study and control groups used a negative binomial regression model. Results Thirty-four patients were reviewed in phase 1a and 197 in phase 1b. Forty study patients completed phase 2 and progressed into phase 3, of whom 30 completed ≥60 therapy days. Patients were lost to follow-up if they discontinued HPN for any reason. Improvements in weight, body mass index and QOL were seen in the study patients during intervention. Recommendations made and accepted by treating physicians differed based on PNE status. Study patients had fewer adverse outcomes and related hospitalisations than controls. Conclusion MNST recommendations improved clinical, biochemical parameters and patients' self-reported overall health. MNST input reduced adverse outcomes, hospitalisation and the length of stay at the hospital. This study highlights the potential for MNST to have a significant impact on the quality and overall cost of HPN management.
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Affiliation(s)
- Michael Rothkopf
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mohan Pant
- School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | | | | | | | | | | | | | | | | | | | | | - Nudrat Ayub
- Atlantic Health System Inc, Florham Park, New Jersey, USA
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11
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Tullie L, Jones BC, De Coppi P, Li VSW. Building gut from scratch - progress and update of intestinal tissue engineering. Nat Rev Gastroenterol Hepatol 2022; 19:417-431. [PMID: 35241800 DOI: 10.1038/s41575-022-00586-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/18/2022]
Abstract
Short bowel syndrome (SBS), a condition defined by insufficient absorptive intestinal epithelium, is a rare disease, with an estimated prevalence up to 0.4 in 10,000 people. However, it has substantial morbidity and mortality for affected patients. The mainstay of treatment in SBS is supportive, in the form of intravenous parenteral nutrition, with the aim of achieving intestinal autonomy. The lack of a definitive curative therapy has led to attempts to harness innate developmental and regenerative mechanisms to engineer neo-intestine as an alternative approach to addressing this unmet clinical need. Exciting advances have been made in the field of intestinal tissue engineering (ITE) over the past decade, making a review in this field timely. In this Review, we discuss the latest advances in the components required to engineer intestinal grafts and summarize the progress of ITE. We also explore some key factors to consider and challenges to overcome when transitioning tissue-engineered intestine towards clinical translation, and provide the future outlook of ITE in therapeutic applications and beyond.
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Affiliation(s)
- Lucinda Tullie
- Stem Cell and Cancer Biology Laboratory, The Francis Crick Institute, London, UK.,Stem Cell and Regenerative Medicine Section, DBC, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Brendan C Jones
- Stem Cell and Regenerative Medicine Section, DBC, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Paolo De Coppi
- Stem Cell and Regenerative Medicine Section, DBC, Great Ormond Street Institute of Child Health, University College London, London, UK. .,Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, UK.
| | - Vivian S W Li
- Stem Cell and Cancer Biology Laboratory, The Francis Crick Institute, London, UK.
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12
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Jones BC, O’Sullivan B, Amin SP, Hill S, Eaton S, De Coppi P. Patient-level costing analysis of paediatric short bowel syndrome care in a specialist tertiary centre. Pediatr Surg Int 2022; 38:533-539. [PMID: 35211770 PMCID: PMC8913464 DOI: 10.1007/s00383-022-05074-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To undertake a pilot study estimating patient-level costs of care for paediatric short bowel syndrome (SBS) from the healthcare provider perspective. METHODS A pilot group of patients with anatomical SBS was selected at a single specialist tertiary centre in the United Kingdom. The Patient Level Information and Costing System (PLICS) was used to extract costing data for all hospital-based activities related to SBS, from the implementation of PLICS in 2016 to April 2021. Patient-specific and pooled data were reported descriptively in per patient-year terms. RESULTS Five patients had full PLICS data available for the 5-year study period and 2 patients had 4 years of data. The median cost for hospital care of SBS was £52,834 per patient-year (range £1804-£331,489). The key cost drivers were inpatient beds, pharmacy, and staffing costs, which made up > 60% of annual costs. In the first 3 years following index admission (n = 2), there was a steady decline in the annual cost of care to a level comparable with patients with established SBS. CONCLUSION Patient-level cost of care analysis for SBS is feasible using PLICS. Hospital-related costs vary widely between and within individual patients over time. Key drivers of cost are related to complications of SBS.
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Affiliation(s)
- Brendan C. Jones
- Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK ,Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, UK
| | - Benjamin O’Sullivan
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | | | - Susan Hill
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Simon Eaton
- Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Paolo De Coppi
- Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK ,Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, UK
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13
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Ribeiro-Mourão F, Bertaud S, Brierley J, McCulloch R, Köglmeier J, Hill SM. Use of home parenteral nutrition in severely neurologically impaired children. Arch Dis Child 2022; 107:365-370. [PMID: 34551897 DOI: 10.1136/archdischild-2021-321850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 09/04/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To review the outcome of children with severe neurological impairment (NI) and intestinal failure (IF) referred to our specialist multidisciplinary IF rehabilitation service and to discuss implications. DESIGN Case report series, descriptive analysis. SETTING IF rehabilitation programme at a tertiary children's hospital in the UK. PATIENTS Children with severe NI referred to our IF rehabilitation programme from 2009 to 2019. MAIN OUTCOME MEASURES Demographic and social data, diagnosis, clinical condition, use of home parenteral nutrition (HPN), complications, ethics review outcome and advance care plans. RESULTS Six patients with severe NI were referred to our IF rehabilitation service. Consent for publication was obtained from five families. After thorough medical review and clinical ethics committee assessment, three children started HPN, one had intravenous fluids in addition to enteral feed as tolerated and one intravenous fluids only. The HPN children survived 3-7.08 years (median 4.42 years) on treatment. Objective gastrointestinal signs, for example, bleeding improved without excessive HPN-related complications. Symptomatic improvement was less clear. Analgesia was reduced in three of the five children. All cases had detailed symptom management and advance care plans regularly updated. CONCLUSIONS HPN can play a role in relieving gastrointestinal signs/symptoms in children with severe NI and IF. HPN can be conceptualised as part of good palliative care if judged to be in the child's best interests. However, given its risks and that HPN has the potential to become inappropriately life-sustaining, a thorough ethics review and evaluation should be performed before it is initiated, withheld or withdrawn in children with severe NI.
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Affiliation(s)
- Francisco Ribeiro-Mourão
- Pediatrics Department, Alto Minho Local Health Unit EPE, Viana do Castelo, Portugal.,Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
| | - Sophie Bertaud
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital for Children, London, UK
| | - Joe Brierley
- Paediatric Bioethics Centre, Great Ormond Street Hospital for Children, London, UK
| | - Renee McCulloch
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jutta Köglmeier
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
| | - Susan M Hill
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
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Vernon-Roberts A, Lopez RN, Frampton CM, Day AS. Meta-analysis of the efficacy of taurolidine in reducing catheter-related bloodstream infections for patients receiving parenteral nutrition. JPEN J Parenter Enteral Nutr 2022; 46:1535-1552. [PMID: 35233792 PMCID: PMC9541343 DOI: 10.1002/jpen.2363] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Parenteral nutrition administered via central venous catheter is an established treatment option for people with intestinal failure. A serious complication of central venous catheters is the high risk of catheter-related blood stream infections (CRBSI). Catheter locking solutions are one strategy for CRBSI prevention, with the solution taurolidine showing beneficial effects. The aim of this meta-analysis was to identify and synthesize evidence to assess taurolidine efficacy against comparators for the prevention of CRBSI for people with intestinal failure on parenteral nutrition. METHODS Six health literature databases were searched for efficacy data of rate of CRBSI for taurolidine versus control among our study population, no study design limits were applied. Individual study data were presented for the number of CRBSI and catheter days, and rate ratio. Overall data were synthesized as a pooled risk ratio, with sub-group analysis by study design, control type, and taurolidine solution. RESULTS Thirty-four studies were included in the final analysis. At the individual level all studies showed superior efficacy of taurolidine versus control for prevention of CRBSI. When the data were synthesized, the pooled risk ratio was 0.49 (95% CI 0.46 to 0.53, p=<0.0001), indicating a 51% decreased risk of CRBSI through the use of taurolidine. Sub-group analysis showed no difference depending on study design (p=0.23), or control type (p=0.37), and a significant difference for taurolidine type (p=0.0005). CONCLUSION Taurolidine showed superior efficacy over controls regardless of study design or comparator group. The results show that taurolidine provides effective CRBSI reduction for people with intestinal failure on parenteral nutrition. This article is protected by copyright. All rights reserved.
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15
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Bioletto F, D’Eusebio C, Merlo FD, Aimasso U, Ossola M, Pellegrini M, Ponzo V, Chiarotto A, De Francesco A, Ghigo E, Bo S. Efficacy of Teduglutide for Parenteral Support Reduction in Patients with Short Bowel Syndrome: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14040796. [PMID: 35215445 PMCID: PMC8880479 DOI: 10.3390/nu14040796] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 12/13/2022] Open
Abstract
Teduglutide has been described as an effective treatment for parenteral support (PS) reduction in patients with short bowel syndrome (SBS). However, a quantitative summary of the available evidence is still lacking. PubMed/Medline, EMBASE, Cochrane library, OVID, and CINAHL databases were systematically searched up to July 2021 for studies reporting the rate of response (defined as a ≥20% reduction in PS) to teduglutide among PS-dependent adult patients. The rate of weaning (defined as the achievement of PS independence) was also evaluated as a secondary end-point. Ten studies were finally considered in the meta-analysis. Pooled data show a response rate of 64% at 6 months, 77% at 1 year and, 82% at ≥2 years; on the other hand, the weaning rate could be estimated as 11% at 6 months, 17% at 1 year, and 21% at ≥2 years. The presence of colon in continuity reduced the response rate (-17%, 95%CI: (-31%, -3%)), but was associated with a higher weaning rate (+16%, 95%CI: (+6%, +25%)). SBS etiology, on the contrary, was not found to be a significant predictor of these outcomes, although a nonsignificant trend towards both higher response rates (+9%, 95%CI: (-8%, +27%)) and higher weaning rates (+7%, 95%CI: (-14%, +28%)) could be observed in patients with Crohn's disease. This was the first meta-analysis that specifically assessed the efficacy of teduglutide in adult patients with SBS. Our results provide pooled estimates of response and weaning rates over time and identify intestinal anatomy as a significant predictor of these outcomes.
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Affiliation(s)
- Fabio Bioletto
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (C.D.); (M.P.); (V.P.); (E.G.)
| | - Chiara D’Eusebio
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (C.D.); (M.P.); (V.P.); (E.G.)
| | - Fabio Dario Merlo
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.D.M.); (U.A.); (M.O.); (A.C.); (A.D.F.)
| | - Umberto Aimasso
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.D.M.); (U.A.); (M.O.); (A.C.); (A.D.F.)
| | - Marta Ossola
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.D.M.); (U.A.); (M.O.); (A.C.); (A.D.F.)
| | - Marianna Pellegrini
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (C.D.); (M.P.); (V.P.); (E.G.)
| | - Valentina Ponzo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (C.D.); (M.P.); (V.P.); (E.G.)
| | - Alessia Chiarotto
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.D.M.); (U.A.); (M.O.); (A.C.); (A.D.F.)
| | - Antonella De Francesco
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.D.M.); (U.A.); (M.O.); (A.C.); (A.D.F.)
| | - Ezio Ghigo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (C.D.); (M.P.); (V.P.); (E.G.)
| | - Simona Bo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (C.D.); (M.P.); (V.P.); (E.G.)
- Correspondence: ; Tel.: +39-011-633-6036
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16
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SINPE Position Paper on the use of home parenteral nutrition in cancer patients. Support Care Cancer 2022; 30:2909-2914. [PMID: 35037119 DOI: 10.1007/s00520-021-06785-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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17
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Folwarski M, Kłęk S, Szlagatys-Sidorkiewicz A, Wyszomirski A, Brzeziński M, Skotnicka M. Trend Observations in Home Parenteral Nutrition. Prevalence, Hospitalizations and Costs: Results from a Nationwide Analysis of Health Care Provider Data. Nutrients 2021; 13:nu13103465. [PMID: 34684466 PMCID: PMC8539115 DOI: 10.3390/nu13103465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The population of patients on home parenteral nutrition (HPN) worldwide is growing. Since only a few counties provide data from national registries long-term observations are valuable to address this specific area of nutrition support. This study is a nationwide analysis determining the trends in the epidemiology of HPN (prevalence, age distribution, death rates), indications for HPN, causes for hospitalizations, and cost analysis of HPN reimbursement in Poland between 2010-2020. METHODS A retrospective analysis of data obtained from the national health fund (NHF) of Poland on adult patients on HPN. RESULTS The prevalence of adult patients on HPN in Poland in 2020 was 53.26 per million citizens with a 2.99-fold increase and a growing trend observed from 2010. Significant decrease in the percentage of patients between 18-34, 45-54 and an increase in patients between 65-74 and patients over 75 years old was observed. Trend analysis showed an increase in new patients between 65-74 and a decrease between 35-54. Malnutrition (34.28%), postprocedural disorders of the GI tract (19.61%), intestinal malabsorption/other intestinal diseases (20.41%) and GI obstruction due to cancer (17.36% as primary and 23.16% as secondary diagnosis) were mostly reported as the primary indications for HPN. Cancer patients were mostly gastric, ovarian and colon cancer (34.74%, 17.83% and 12.3%). HPN and total health cost reimbursement increase was 2.6 and 2.57-fold respectively. Costs of HPN and total health care costs in 2020 per patient were € 10,015 and € 16,038, respectively. Overall death risk rate during the first year of nutrition was 0.59 with a significant increase in the observation period p-trend < 0.004. A significant increase in the death rate was observed in patients above 75 years old (estimate 1.629, p-trend < 0.030). Cancer, infection, malnutrition and GI symptoms were the most common indications for hospitalizations of HPN patients. The rate of patients with a maximal length of HPN of 5 months in 2010 was 54.9% and was growing up to 78.1% in 2020. CONCLUSIONS The prevalence of HPN in Poland is growing. Trends of age distribution show increasing numbers of patients with more advanced age and shorter survival. Costs of HPN are comparable with other European data.
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Affiliation(s)
- Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, 80-210 Gdańsk, Poland
- Home Enteral and Parenteral Nutrition Unit, General Surgery Department, Nicolaus Copernicus Hospital, 80-803 Gdańsk, Poland
- Correspondence: ; Tel.: +48-58-349-27-23
| | - Stanisław Kłęk
- Surgical Oncology Clinic, Maria Sklodowska-Curie National Cancer Institute, 31-501 Kraków, Poland;
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (A.S.-S.); (M.B.)
| | - Adam Wyszomirski
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Michał Brzeziński
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (A.S.-S.); (M.B.)
| | - Magdalena Skotnicka
- Department of Commodity Science, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
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Siu AHY, Carey S, Jones L, Morton RL, Koh CE. Detailed analysis of in-hospital costs for adult patients with type III intestinal failure: A single-center study with global implications. JPEN J Parenter Enteral Nutr 2021; 46:685-692. [PMID: 33929048 DOI: 10.1002/jpen.2136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is the recommended treatment for patients with type III intestinal failure (IF). However, owing to IF's rarity, the economic cost of managing these patients is not well understood. These patients often develop complications resulting in readmissions, which in turn contribute to ongoing costs. This study aims to document the costs of type III IF within the hospital, from initial admission, including readmissions, and to compare incurred costs with current government reimbursement. METHODS A retrospective study design reviewed costs and reimbursement for 25 consecutive patients commencing HPN at a quaternary hospital (October 2011 to September 2017). Hospital admissions were separated into the initial admission and readmission(s) period. Healthcare use and cost data were collected using electronic medical records. Hospital reimbursement costs were retrieved from Sydney Local Health District's Targeted Activity and Reporting Systems. Patient demographics were tabulated, and healthcare use and cost data were compared using Wilcoxon signed rank tests. RESULTS The median cost of the initial hospital admission was substantially higher than the median reimbursement ($36,675; interquartile range [IQR], $23,196-$67,439 vs $19,247; IQR, $7485-$41,090; P < .001). Similar results were observed in the readmissions period, with median incurred costs of $13,898; (IQR, $11,151-$32,130) vs reimbursement of $8469 (IQR, $5625-$13,078) (P = .001). CONCLUSION Results indicate that type III IF patients have high inpatient costs, which substantially outweigh current reimbursement. Improved funding models are needed to ensure hospitals that accept the management challenge of type III IF patients are not unduly penalized.
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Affiliation(s)
- Adrian H Y Siu
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.,Graduate School of Medicine, University of Wollongong, NSW, Australia
| | - Sharon Carey
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.,Department of Dietetics and Nutrition, Royal Prince Alfred Hospital, Sydney, Australia.,School of Life and Environmental Sciences, University of Sydney, Sydney, Australia.,Intestinal Failure and Home Parenteral Nutrition Service, Royal Prince Alfred Hospital, Sydney, Australia
| | - Lynn Jones
- Intestinal Failure and Home Parenteral Nutrition Service, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Cherry E Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.,Intestinal Failure and Home Parenteral Nutrition Service, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Discipline of Surgery, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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