Modelled effects of a pediatric triple-chamber-bag (3CB) system on payer costs and clinical outcomes in pre-term neonates across France, Germany, and Italy

Kriz A, Migliore A, Wright A, Piaggio T. Modelled effects of a pediatric triple-chamber-bag (3CB) system on payer costs and clinical outcomes in pre-term neonates across France, Germany, and Italy. Value Health 2018;21(Suppl 3): S216–7

Abstract

Objectives: To model potential costs and clinical outcomes with different sources of Parenteral Nutrition (PN) compounds for pre-term neonates.

Methods: A cost-consequence analysis was performed using a deterministic model developed with inputs from an existing budget impact model, most of which were derived from interviews with 12 hospitals in Belgium, France, Germany, and the UK. The model was applied to estimate payer costs and clinical impact associated with six PN preparation methods. Data captured were ingredients, equipment, staff-time and PN associated nutrition errors, complications, and clinical events avoided or gained. PN preparation methods were manual or automated pharmacy, ward, industry, third party outsourced compounding and a pediatric 3CB system. Compounding error rate estimates of 37%, 22%, 37%, 1%, 1.7%, and 1%, respectively were derived from Flynn 1997 and Dickson 1993. Infection rate estimates of 0.66% PN-days for manual pharmacy compounding, which we increased by 10% with ward compounding, and decreased by 10% and 19% with outsourced compounding and industry / 3CBs, respectively which were calculated from Hoang 2008.

Results: Of ∼145,000 premature babies annually, across Germany, France and Italy, 52% are estimated to receive PN. Estimated, overall preparation method share is 30% manual and 17% automated pharmacy, 38% ward, 3% outsourced, 8% industry compounded and 3% pediatric 3CBs. By increasing the 3CB share by 10% to 13%, leading to 27%, 15%, 35%, 3%, and 7% distribution, respectively, an estimated 152 blood stream infections, 114 severe compounding errors, and 994 significant compounding errors may be avoided. Additionally, up to 16 pharmacists, 13 pharmacy assistants, 9 physicians and 20 nurses could be transferred to other important clinical responsibilities. The overall hospital budget impact, across all three countries, would decrease by € 10 million.

Conclusions: Providing nutritional support to pre-term babies with pediatric 3CB would have substantial cost savings and clinical benefits.