• Madhuri Pattamatta, EversSilvia M A ASMAAhttp://orcid.org/0000-0003-1026-570Xa Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.b Trimbos Institute of Mental Health and Addiction ,, SmeetsBoudewijn J JBJJc Department of Surgery , Catharina Hospital Eindhoven , Eindhoven , The Netherlands.d GROW School of Oncology and Developmental Biology , Maastricht University , Maastricht , The Netherlands., Emmeline G Peters, LuyerMisha D PMDPhttp://orcid.org/0000-0002-9483-1520c Department of Surgery , Catharina Hospital Eindhoven , Eindhoven , The Netherlands., and Mickael Hiligsmann.
• a Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.
• J Med Econ. 2019 Mar 1; 22 (3): 238-244.

AimsThe 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 MethodsAlongside 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.ResultsIn 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 vs 83, p = .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 statistical significance (p = .109). The intervention resulted in an ICER of -€6,276 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.LimitationsThe 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 for 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 post-operatively where the effects could potentially be higher.ConclusionsThis study suggests that perioperative nutrition is not beneficial for the patients in terms of quality-of-life and is not cost-effective.

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