Early versus delayed enteral nutrition in critically ill children under 12 years of age: an economic evaluation.

INTRODUCTION: Nutritional support is an integral part of treating critically ill children in paediatric intensive care units (PICUs). Early enteral nutrition (EEN) in the PICU has been shown to have greater benefits compared to delayed enteral nutrition (DEN) in reducing PICU and hospital stays and lowering mortality. In this study, we conducted a cost comparison and cost-effectiveness analysis of early versus delayed enteral nutrition during PICU and hospital stays for children aged 1 month to 12 years in Malawi. METHODS: We used primary and secondary data to cost PICU and hospital admissions from a payer perspective. We developed a stochastic model that assumed that equal cohorts of 500 critically ill children were admitted to the PICU and provided with EEN and DEN. Using the average length of stay in the PICU and hospital and cost data, we estimated total cohort costs and the average cost per patient for each strategy. We estimated disability-adjusted life years (DALYs) and used the total hospital costs to estimate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the results. RESULTS: The total cohort cost for EEN in the PICU was lower, $479,850, than that for DEN, $515,623. The total cohort costs for the hospital stay were also lower for EEN, $564,290, than for DEN, $613,902. The average cost per patient for EEN in the PICU was lower at $960 than $1031 for DEN. The average cost per patient for the hospital was also lower for EEN, $1129, than for DEN, $1228. EEN dominated DEN and the ICER was estimated as -$39.47/DALY averted. Probabilistic sensitivity analysis showed that EEN had a greater probability of being cost-effective, for a capacity to pay or cost-effectiveness threshold range of 0$-2000$/DALY averted, than DEN. Scaling up the implementation of EEN led to higher net monetary and health benefits. CONCLUSION: EEN in children aged 1 month to 12 years was found to be less costly and more cost-effective than DEN in Malawi.