Five-day preoperative immunonutrition in patients undergoing major surgery for gastrointestinal cancer: A cost-effectiveness analysis under the brazilian healthcare system perspective

• Pedro E. P. Filho ^[1] ; Guilherme A. G. Ravanini ^[1] ; Ana C. P. Ribeiro-Pereira ^[2] ; Lucas Fahham ^[2] ; Roberta A. Fernandes ^[2] ; Victoria M. R. Pagliosa ^[3] ; Valeria A. S. Rosenfeld ^[3]
  1. [1] Universidade Federal do Estado do Rio de Janeiro

     Universidade Federal do Estado do Rio de Janeiro

     Brasil

     
  2. [2] ORIGIN Health. São Paulo, São Paulo. Brazil
  3. [3] Nestlé Health Science. São Paulo, São Paulo. Brazil

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• Localización: Nutrición hospitalaria: Órgano oficial de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE), ISSN-e 1699-5198, ISSN 0212-1611, Vol. 42, Nº. 5, 2025, págs. 1039-1046
• Idioma: inglés
• DOI: 10.20960/nh.05553
• Títulos paralelos:
  • Inmunonutrición preoperatoria durante 5 días en pacientes sometidos a cirugía mayor por cáncer gastrointestinal:: Un análisis de coste-efectividad desde la perspectiva del sistema de salud brasileño
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• Resumen
  • español

    Objetivos: este estudio tiene como objetivo evaluar la relación coste-efectividad de la inmunonutrición enteral u oral preoperatoria durante 5 días en pacientes sometidos a cirugía mayor por cáncer gastrointestinal desde la perspectiva del Sistema Único de Salud (SUS) de Brasil. También se realizó un análisis del impacto presupuestario.

    Métodos: se construyó un modelo de árbol de decisión para comparar la inmunonutrición enteral u oral con la dieta estándar, considerando un horizonte temporal de 5 + 30 días. Para determinar los resultados de eficacia, se recuperaron estudios que utilizaron inmunonutrición preoperatoria de 5 días a partir de un metaanálisis previamente publicado. Se calcularon nuevas estimaciones combinadas para la ocurrencia de complicaciones infecciosas, complicaciones no infecciosas, duración de la hospitalización y mortalidad a los 30 días utilizando estudios con una intervención de 5 días. Las estrategias de tratamiento se compararon utilizando la razón de coste-efectividad incremental (RCEI). Los costes se informaron en reales brasileños (BRL) y euros (EUR).

    Resultados: los resultados combinados a través del metaanálisis mostraron que la ocurrencia de complicaciones infecciosas fue del 17,2 % (65/378) y del 28,8 % (99/344) para el grupo de inmunonutrición y el grupo de control, respectivamente (OR = 0,46; IC 95 % = 0,28-0,78;

    p = 0,003). Al considerar los costes totales por procedimiento, se observaron estimaciones de 930,56 BRL/151,31 EUR (267,75 BRL/43,54 EUR debido a la inmunonutrición y 662,81 BRL/107,77 EUR debido al manejo de complicaciones infecciosas) y 1.109,29 BRL/180,37 EUR (0,0 BRL/ EUR debido a la dieta estándar y 1.109,29 BRL/180,37 EUR debido al manejo de complicaciones infecciosas) para los grupos de inmunonutrición y dieta estándar, respectivamente. El análisis de coste-efectividad mostró que la inmunonutrición redujo la ocurrencia de complicaciones infecciosas (-12 %) con costes más bajos (-178,73 BRL/-29,06 EUR). El ahorro total en 5 años fue de aproximadamente 5 millones de BRL/817.352 EUR.

    Conclusión: la inmunonutrición enteral u oral preoperatoria durante 5 días no solo tiene un impacto clínico positivo para los pacientes sometidos a cirugía mayor por cáncer gastrointestinal, sino que también puede generar reducciones sustanciales en los costes para el SUS

  • English

    Objectives: this study aims to evaluate the cost-effectiveness of 5-day preoperative enteral or oral immunonutrition in patients undergoing major surgery for gastrointestinal cancer, under the Brazilian Unifi ed Health System (Sistema Único de Saúde – SUS) perspective. A budget impact analysis was also performed.

    Methods: a decision tree model was built to compare enteral or oral immunonutrition with the standard diet, considering a time horizon of 5 + 30 days. To determine the effi cacy outcomes, studies using 5-day preoperative immunonutrition were retrieved from a previously published meta-analysis. New combined estimates for the occurrence of infectious complications, non-infectious complications, length of stay, and 30-day mortality were calculated using studies with a 5-day period intervention. Treatment strategies were compared using the incremental cost-effectiveness ratio (ICER). Costs were reported in Brazilian reals (BRL) and euros (EUR).

    Results: results combined through the meta-analysis showed that the occurrence of infectious complications was 17.2 % (65/378) and 28.8 % (99/344) for the immunonutrition and the control group, respectively (OR = 0.46; 95 % CI = 0.28-0.78; p = 0.003). Considering total costs by procedure, estimates of 930.56 BRL/151.31 EUR (267.75 BRL/43.54 EUR due to immunonutrition and 662.81 BRL/107.77 EUR due to infectious complications management) and 1,109.29 BRL/180.37 EUR (0.0 BRL/EUR due to standard diet and 1,109.29 BRL/180.37 EUR due to infectious complications management) were observed for immunonutrition and standard diet groups, respectively. Cost-effectiveness analysis showed that immunonutrition reduced the occurrence of infectious complications (-12 %) with lower costs (-178.73 BRL/-29.06 EUR). Total savings over 5 years was approximately 5 million BRL/817,352 EUR.

    Conclusion: 5-day preoperative enteral or oral immunonutrition not only has a positive clinical impact for patients undergoing major surgery for gastrointestinal cancer but can also generate substantial reductions in costs for SUS

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