Cost analysis of Omega-3 supplementation in critically ill patients with sepsis

Kwadwo Kyeremanteng; Jennifer Shen; Kednapa Thavorn; Shannon M Fernando; Brent Herritt; Dipayan Chaudhuri; Peter Tanuseputro

doi:10.1016/j.clnesp.2018.04.003

Cost analysis of Omega-3 supplementation in critically ill patients with sepsis

Clin Nutr ESPEN. 2018 Jun:25:63-67. doi: 10.1016/j.clnesp.2018.04.003. Epub 2018 Apr 19.

Authors

Kwadwo Kyeremanteng¹, Jennifer Shen², Kednapa Thavorn³, Shannon M Fernando³, Brent Herritt³, Dipayan Chaudhuri³, Peter Tanuseputro⁴

Affiliations

¹ University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada; The Ottawa Hospital General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L2, Canada; Institut du-savoir Montfort, Gloucester, ON, Canada. Electronic address: kkyeremanteng@toh.ca.
² The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ University of Ottawa, Ottawa, ON, Canada.
⁴ Bruyère Research Institute, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada.

PMID: 29779820
DOI: 10.1016/j.clnesp.2018.04.003

Abstract

Introduction: Nutritional supplement of omega-3 fatty acids have been proposed to improve clinical outcomes in critically ill patients. While previous work have demonstrated that omega-3 supplementation in patients with sepsis is associated with reduced ICU and hospital length of stay, the financial impact of this intervention is unknown.

Objective: Perform a cost analysis to evaluate the impact of omega-3 supplementation on ICU and hospital costs.

Methods: We extracted data related to ICU and hospital length of stay from the individual studies reported in a recent systematic review. The Cochrane Collaboration tool was used to assess the risk of bias in these studies. Average daily ICU and hospital costs per patient were obtained from a cost study by Kahn et al. We estimated the ICU and hospital costs by multiplying the mean length of stay by the average daily cost per patient in ICU or Hospital. Adjustments for inflation were made according to the USD annual consumer price index. We calculated the difference between the direct variable cost of patients with omega-3 supplementation and patients without omega-3 supplementation. 95% confidence intervals were estimated using bootstrap re-sampling procedures with 1000 iterations.

Results: A total of 12 RCT involving 925 patients were included in this cost analysis. Septic patients supplemented with omega-3 had both lower mean ICU costs ($15,274 vs. $18,172) resulting in $2897 in ICU savings per patient and overall hospital costs ($17,088 vs. $19,778), resulting in $2690 in hospital savings per patient. Sensitivity analyses were conducted to investigate the impact of different study methods on the LOS. The results were still consistent with the overall findings.

Conclusion: Patients with sepsis who received omega-3 supplementation had significantly shorter LOS in the ICU and hospital, and were associated with lower direct variable costs than control patients. The 12 RCTs used in this analysis had a high risk of bias. Large-scaled, high-quality, multi-centered RCTs on the effectiveness of this intervention is recommended to improve the quality of the existing evidence.

Keywords: Costs; Critical illness; Healthcare economics; Intensive care unit; Omega-3; Sepsis.

MeSH terms

Cost Savings
Cost-Benefit Analysis
Critical Illness
Dietary Supplements / adverse effects
Dietary Supplements / economics*
Fatty Acids, Omega-3 / administration & dosage*
Fatty Acids, Omega-3 / adverse effects
Fatty Acids, Omega-3 / economics*
Hospital Costs*
Humans
Intensive Care Units / economics*
Length of Stay / economics
Models, Economic
Sepsis / diagnosis
Sepsis / economics*
Sepsis / physiopathology
Sepsis / therapy*
Systematic Reviews as Topic
Time Factors
Treatment Outcome

Substances

Fatty Acids, Omega-3