Cost-consequences analysis of paediatric triple-chamber-bags (3CBS) impact on hospital resources and clinical outcomes in preterm neonates across Belgium, Portugal, Spain, and the UK

Kriz A, Wright A, Paulsson M, Tomlin S, Simchowitz V, Migliore A, Senterre T, Shepelev J. Cost-consequences analysis of paediatric triple-chamber-bags (3CBS) impact on hospital resources and clinical outcomes in preterm neonates across Belgium, Portugal, Spain, and the UK. Value Health 2019:22(Suppl 3):S414

Abstract

Objectives: Economic modelling to evaluate potential cost and clinical effects of including 3CBs in parenteral nutrition (PN) regimens for preterm neonates.

Methods: A deterministic cost-consequence analysis was performed to estimate hospital costs and clinical impact of a 10% increased utilisation of 3CBs in preterm neonatal population in Belgium, Portugal, Spain and the UK. Included data variables were ingredients, consumables, staff-time and PN associated compounding errors, complications, and clinical events avoided or gained. Five PN preparation methods were considered: pharmacy (manual or automated), ward, outsourced third party and 3CBs with an estimated compounding error rate baseline of 37%, 22%, 37%, 1.7%, and 1%, respectively, derived from Flynn 1997 and Dickson 1993. Infection rate estimates of 0.66% per day of PN for manual pharmacy compounding, which was increased by 10% with ward compounding, and decreased by 10% and 19% with outsourced compounding and 3CBs, respectively which were calculated from Hoang 2008.

Results: Across four countries, in approximately 120,000 preterm neonatal births annually, 52% are estimated to receive PN regimens. The overall current estimated share of PN preparation methods is 64% in manual and 9% in automated pharmacy, 4% in ward, 13% outsourced and 10% pediatric 3CBs. Increasing 3CBs utilization by 10 % would lead to 57% manual, 8% automated, 3% ward and 13% outsourced distribution, and as a result, an estimated 91 blood stream infections, 47 severe compounding errors, and 406 significant compounding errors can be avoided annually. Additionally, up to 17 pharmacists, 17 pharmacy assistants and 8 neonatologists could optimise their time in provision of care. The overall potential incremental hospital cost-savings would be around € 2.6 million across four European countries.

Conclusions: The use of pediatric 3CBs may provide substantial cost-savings to hospitals and clinical benefits to preterm neonates.