EFFECTIVENESS AND COST-EFFECTIVENESS OF SUPPLEMENTAL GLUTAMINE DIPEPTIDE IN TOTAL PARENTERAL NUTRITION THERAPY FOR CRITICALLY ILL PATIENTS: A DISCRETE EVENT SIMULATION MODEL BASED ON ITALIAN DATA

Introduction: The supplementation of alanyl-glutamine dipeptide in critically ill patients necessitating total parenteral nutrition (TPN) improves clinical outcomes, reducing mortality, infection rate, a shortening intensive care unit (ICU) hospital lengths of stay (LOSs), as compared to standard TPN regimens. Methods: A Discrete Event Simulation model that incorporates outcomes rates from 200 Italian ICUs for over 60,000 patients, alanyl-glutamine dipeptide efficacy data synthesized by means of a Bayesian random effects meta-analysis, and national cost data has been developed to evaluate the alternatives from the cost perspective of the hospital. Simulated clinical outcomes are death and infection rates in ICU, death rate in general ward, and hospital LOSs. Sensitivity analyses are performed by varying all uncertain parameter values in a plausible range. Results: The internal validation process confirmed the accuracy of the model in replicating observed clinical data. Alanyl-glutamine dipeptide on average results more effective and less costly than standard TPN: reduced mortality rate (24.6% +/- 1.6% vs. 34.5% +/- 2.1%), infection rate (13.8% +/- 2.9% vs. 18.8% +/- 3.9%), and hospital LOS (24.9 +/- 0.3 vs. 26.0 +/- 0.3 days) come at lower total cost per patient (23,409 +/- 3,345 vs. 24,161 +/- 3,523 Euro). Treatment cost is completely offset by savings on ICU and antibiotic costs. Sensitivity analyses confirmed the robustness these results. Conclusions: Alanyl-glutamine dipeptide is expected to improve clinical outcomes and to do so with a concurrent saving for the Italian hospital