An economic evaluation of perioperative enteral nutrition in patients undergoing colorectal surgery (SANICS II study).

AIMS: The objective of this (trial based) economic evaluation was to assess, from a societal perspective, the cost-effectiveness of perioperative enteral nutrition compared with standard care in patients undergoing colorectal surgery.

MATERIALS AND METHODS: Alongside the SANICS II randomized controlled trial, global quality of life, utilities (measured by EQ-5D-5L), healthcare costs, production losses, and patient and family costs were assessed at baseline, 3 months, and 6 months. Incremental cost effectiveness ratios (ICERs) (i.e. cost per increased global quality of life score or quality-adjusted life year [QALY] gained) and cost effectiveness acceptability curves were visualized.

RESULTS: In total, 265 patients were included in the original trial (n = 132 in the perioperative enteral nutrition group and n = 133 in the standard care group). At 6 months, global quality of life (83 versus 83, p = 0.357) did not differ significantly between the groups. The mean total societal costs for the intervention and standard care groups were €14,673 and €11,974 respectively but did not reach the statistical significance (p = 0.109). The intervention resulted in an ICER of -€6276 per point increase in the global quality of life score. The gain in QALY was marginal (0.003) with an additional cost of €2,941 and the ICUR (Incremental cost utility ratio) was estimated at €980,333.

LIMITATIONS: The cost elements for all the participating centers reflect the reference prices from the Netherlands. Patient-reported questionnaires may have resulted in recall bias. Sample size was limited by exclusion of patients who did not complete questionnaires at least at two time points. A power analysis based on costs and health related quality of life (HRQoL) was not performed. The economic impact could not be analyzed at 1 month postoperatively where the effects could potentially be higher.

CONCLUSIONS: This study suggests that perioperative nutrition is not beneficial for the patients in terms of quality of life and is not cost effective.