Cost analysis of long-term feeding by percutaneous endoscopic gastrostomy in cancer patients in an Italian health district
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The aim of this study was to evaluate prospectively the cost of long-term feeding by percutaneous endoscopic gastrostomy (PEG). Cost analysis was carried out in 34 head and neck cancer patients, followed from the time of PEG placement to the death or the end of the study. Three main items were considered: (a) PEG placement (on an inpatient basis), subdivided into five subitems: the Freka FK-07 gastrostomy kit, materials and anaesthetic drugs used, antibiotics and antisecretory drugs, gastroscope amortization expenses and staff; (b) nutrition, considering the costs of enteral-feeding products, nutrition container and flexible tube connecting the container to the PEG; (c) patient care, dividing the patients into three groups: outpatients, home-care patients and outpatients shifting to home care during the follow-up. All patients had one medical and two nursing visits/month, and, if necessary, immediate additional access to a physician or nurse. The mean daily cost per patient of long-term feeding via PEG was obtained by adding up the mean daily costs per patient of the three items, and was compared with that of feeding via nasogastric tube, calculated in 11 patients using the same criteria. No procedure-related death nor periprocedural major or minor complications were observed. The 60-day mortality was 3/34. Seventeen patients were always seen on an outpatient basis and 8 were followed by our home-care unit; 9 outpatients shifted to home care during the follow-up. The mean duration of PEG use was 180.5 days (range 47–639). Two wound infections, treated with antibiotics, occurred during the follow-up. The mean daily costs of placement, nutrition and patient care were (Italian liras) L 2500, 24 510 and 1880 respectively (Deutschemarks: DM 2.08, 20.42 and 1.56), for a total mean daily cost of L 28,890 (DM 24.06), slightly higher than that of feeding via a nasogastric tube (L 27,340; DM 22.78). On the basis of the improved quality of life, as well as from the economic point of view, PEG can be considered the procedure of choice for enteral feeding of cancer patients, provided that a reasonably long survival can be expected.
Key wordsCost analysis Enteral feeding Percutaneous endoscopic gastrostomy
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- 5.Jones M, Santanello SA, Falcone RE (1990) Percutaneous endoscopic vs surgical gastrostomy. J Parenter Enteral Nutr 14:533–534Google Scholar
- 6.Kinney JA (1980) Caloric and nitrogen requirements in catabolic states. In: Karran SJ, Alberti KGM (eds) Practical nutritional support. Pitman, London, pp 81–93Google Scholar
- 7.Kirby DF, Craig RM, Tsang TK, Plotnick BH (1986) Percutaneous endoscopic gastrostomies. A prospective evaluation and review of the literature. J Parent Enteral Nutr 10:155–159Google Scholar
- 10.Nelson JK, Palumbo PJ, O'Brien PC (1986) Home enteral nutrition: observations of a newly established program. Nutr Clin Pract 1:193–199Google Scholar
- 11.Park RHR, Allison MC, Lang J, Spence E, Morris AJ, Danesh BJZ, Russel RI, Mills PR (1992) Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. Br Med J 304:1406–1409Google Scholar
- 12.Sartori S, Trevisani L, Donati D, Gilli G, Tassinari D, Nielsen I, Malacarne P (1993) Percutaneous endoscopic gastrostomy. Personal experience and preliminary results of a long-term follow-up. Riv Ital Nutr Parenter Enter 11:174–181Google Scholar
- 15.The Criteria Committee of the New York Heart Association (1979) Nomenclature and criteria for diagnosis of diseases of the heart and great vessels, 8th edn. New York Heart Association, New YorkGoogle Scholar
- 17.Wicks C, Gimson A, Vlavianos P, Lombard M, Panos M, Macmathuna P, Tudor M, Andrews K, Westaby D (1991) Assessment of the percutaneous endoscopic gastrostomy feeding tube as part of an integrated approach to enteral feeding. Gut 33:613–616Google Scholar