Cost Savings of Home Parenteral Nutrition Compared to Hospital Parenteral Nutrition: A Multicentre Prospective Analysis

Abstract

BACKGROUND Parenteral nutrition (PN) is a safe and effective type of nutrition support. Several publications demonstrate the impact of Home Parenteral Nutrition (HPN) reducing health care costs. The question is, are HPN practices in Latin America also cost saving when compared with hospital PN? This study aimed to compare the direct costs of healthcare and non-healthcare of HPN to Hospital PN costs in Argentina through a prospective, analytical, and longitudinal, multicentre non-interventional study. MATERIALS AND METHODS Adult Patients with PN were included and followed during the last week of Hospital PN (Week − 1 before discharge), through the first week of HPN (Week + 1), and until the first month of HPN (Month + 1). Clinical, nutritional, and cost variables were recorded. Continuous variables (mean ± SD or median Q1–Q3), were tested whit T-tests or Wilcoxon signed rank test. Categorical (frequencies and percentages) were tested with the McNemar test. The total direct cost (Total Direct healthcare cost + Total Direct non-healthcare cost) from Hospital PN Week − 1 was compared with HPN Week + 1. Additionally, HPN Month + 1 was compared with an estimate of the total costs of Hospital PN Month − 1. A difference was considered significant with a two-sided p-value < 0.05. Statistical analysis was performed using IBM-SPSS 26. RESULTS Forty-four patients met the inclusion/exclusion criteria and were included for analysis. Comparing HPN Week + 1 vs Hospital PN Week − 1. HPN was associated with lower total direct healthcare costs (HPN U$S 2.863,1+/-633,1 vs Hospital PN U$S 4.361,2+/-743,1. P < 0,001 Mean Difference U$S − 1.498,1 CI 95% -1.203,2 : -1.789,9). Lastly, the total direct cost (healthcare and non-healthcare) was lower in the HPN setting vs. the Hospital setting for 1 week (U$S 2.987,4+/-639 vs. 4439,8+/-761,5 P < 0.001 Mean Difference U$S -1.452,0 CI 95% -1.756,28 : -1.148,4). The cost reduction of HPN for 1 week was 32% (20.3% − 42.8%) and for 1 month was 36% (27.5% − 48.5%). CONCLUSIONS: HPN is cost saving compared to Hospital PN. The major cause of this cost reduction is mostly related to direct Healthcare costs.