The economics of home parenteral nutrition

During the past 30 y long-term parenteral nutrition has evolved from a novel technique to a well-established intervention for gastrointestinal failure. The development of home care has been driven by technological advances and patient/family choice as well as financial constraints, reflecting a shift in resources from hospital to community. Annual costs for adult home parenteral nutrition have recently been estimated to range from US $150 000–250 000 in the USA, and are around £55 000 in the UK, perhaps only 25–50% of in-hospital costs. In the absence of any alternative treatment for children with gastrointestinal failure, parenteral nutrition is life saving, and when performed at home offers the prospect of maintaining a good quality of life. Cost-utility appraisals of home parenteral nutrition in adults incorporating quality of life assessment have shown the cost of one quality adjusted life year to be around £69 000 in the UK (1995), and Can $14 600 in Canada (1984), making home parenteral nutrition relatively cost-effective compared with other ways of spending money to improve health. Because there are no published economic appraisals of pediatric home parenteral nutrition, this paper is based on a review of the literature relating to adult patients.