Abstract
BackgroundOmega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions. Here, we evaluate the impact of ω-3 FA-containing PN versus standard PN on clinical outcomes and costs in adult intensive care unit (ICU) patients using a meta-analysis and subsequent cost-effectiveness analysis from the perspective of a hospital operating in five European countries (France, Germany, Italy, Spain, UK) and the US.MethodsWe present a pharmacoeconomic simulation based on a systematic literature review with meta-analysis. Clinical outcomes and costs comparing ω-3 FA-containing PN with standard PN were evaluated in adult ICU patients eligible to receive PN covering at least 70% of their total energy requirements and in the subgroup of critically ill ICU patients (mean ICU stay > 48 h). The meta-analysis with the co-primary outcomes of infection rate and mortality rate was based on randomized controlled trial data retrieved via a systematic literature review; resulting efficacy data were subsequently employed in country-specific cost-effectiveness analyses.ResultsIn adult ICU patients, ω-3 FA-containing PN versus standard PN was associated with significant reductions in the relative risk (RR) of infection (RR 0.62; 95% CI 0.45, 0.86; p = 0.004), hospital length of stay (HLOS) (− 3.05 days; 95% CI − 5.03, − 1.07; p = 0.003) and ICU length of stay (LOS) (− 1.89 days; 95% CI − 3.33, − 0.45; p = 0.01). In critically ill ICU patients, ω-3 FA-containing PN was associated with similar reductions in infection rates (RR 0.65; 95% CI 0.46, 0.94; p = 0.02), HLOS (− 3.98 days; 95% CI − 6.90, − 1.06; p = 0.008) and ICU LOS (− 2.14 days; 95% CI − 3.89, − 0.40; p = 0.02). Overall hospital episode costs were reduced in all six countries using ω-3 FA-containing PN compared to standard PN, ranging from €-3156 ± 1404 in Spain to €-9586 ± 4157 in the US.ConclusionThese analyses demonstrate that ω-3 FA-containing PN is associated with statistically and clinically significant improvement in patient outcomes. Its use is also predicted to yield cost savings compared to standard PN, rendering ω-3 FA-containing PN an attractive cost-saving alternative across different health care systems.Study registrationPROSPERO CRD42019129311.
Highlights
Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions
Sepsis was not evaluated for the subgroup of critically ill patients, as the minimum observation requirement was not met. ω-3 FA-containing PN was associated with a non-significant 10% relative risk reduction in 30-day mortality in all intensive care unit (ICU) patients and the subgroup of critically ill ICU patients across 12 studies with 925 patients (RR 0.90; 95% Confidence interval (CI) 0.69, 1.16; p = 0.41) and 10 studies with 835 patients (RR 0.90; 95% CI 0.69, 1.16; p = 0.41), respectively (Fig. 3a, b)
hospital length of stay (HLOS) was reported in 11 studies with 872 ICU patients and 8 studies with 742 critically ill ICU patients: both patient groups exhibited significant reductions in mean HLOS with ω-3 FA-containing PN of − 3.05 days and − 3.98 days, respectively (Fig. 4a, b)
Summary
Omega-3 (ω-3) fatty acid (FA)-containing parenteral nutrition (PN) is associated with significant improvements in patient outcomes compared with standard PN regimens without ω-3 FA lipid emulsions. Following concerns that ω-6 PUFAs might have pro-inflammatory and immunosuppressive properties, mixtures of different lipid sources were developed to partially replace linoleic acid and α-linolenic acid in PN with mediumchain triglycerides, monounsaturated fatty acids from olive oil and/or eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from fish oil [1, 4]. Omega-3 (ω-3) FAs derived from fish oil may offer clinical benefits across a wide spectrum of patients, including patients in an intensive care unit (ICU), due to their effects on antiinflammatory, immunomodulatory, and pro-resolution pathways [1, 3, 4]
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