Cost-Effectiveness of Early Oral Feeding Following Total Gastrectomy

BACKGROUND- Gastric cancer is a major health problem worldwide. Effectiveness of early oral feeding (EOF) following gastrectomy has been internationally evaluated, even though there is limited evidence available. In Japan, recently, a randomized controlled trial of EOF following total gastrectomy showed a decreased length of hospital stay, compared with conventional oral feeding (COF). To evaluate value for money of EOF following gastrectomy, cost-effective analysis was carried out based on this trial. METHODS- The analysis was carried out from a societal perspective as the base case. The subjects were randomly assigned to the EOF group (N=32) and the COF group (N=30). While the EOF group received a special diet (i.e., iEAT) from the postoperative day (POD) 1 to POD 3, the COF group received conventional diet (i.e., a liquid diet or rice gruel) on POD 4 and thereafter. The observation period was 3 weeks after total gastrectomy. As an effectiveness measure, quality-adjusted life days (QALDs) were estimated. Quality of life for health conditions was evaluated by using EuroQol-5Dimentions (EQ-5D)-3Levels among the subjects. Costs (e.g., nutritional support, hospitalization and treatment of adverse events) were estimated from trial data during observation. Qualitative and stochastic sensitivity analyses were performed to examine the robustness of the results. RESULTS- The mean QALDs per patient for the EOF and the COF groups were 14.93 and 14.19, respectively. Incremental effectiveness of the EOF group to the COF group was 0.74 QALDs (p=0.359, t-test). The mean total cost per patient in the EOF and the COF groups was $3,177.7 and $3,755.4, respectively. Incremental cost was -$577.7 (p=0.03, t-test, Welch). This means EOF is dominant (cost saving). The qualitative sensitivity analysis and the stochastic sensitivity analysis showed the relative robustness of these results. CONCLUSIONS- Economic evaluation of EOF following total gastrectomy showed that EOF was cost-saving, with non-significant increase in effectives (i.e., QALD), compared with COF. This result can contribute to strengthen the evidence for wide use of EOF.