COST-ANALYSIS OF LONG-TERM FEEDING BY PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CANCER-PATIENTS IN AN ITALIAN HEALTH DISTRICT

The aim of this study was to evaluate prospectively the cost of long-t erm feeding by percutaneous endoscopic gastrostomy (PEG). Cost analysi s was carried out in 34 head and neck cancer patients, followed from t he time of PEG placement to the death or the end of the study. Three m ain items were considered: (a) PEG place ment (on an inpatient basis), subdivided into five subitems: the Freka FK-07 gastrostomy kit, mater ials and anaesthetic drugs used, antibiotics and antisecretory drugs, gastroscope amortization expenses and staff; (b) nutrition, considerin g the costs of enteral-feeding products, nutrition container and flexi ble tube connecting the container to the PEG; (c) patient care, dividi ng the patients into three groups: outpatients, home-care patients and outpatients shifting to home care during the follow-up. All patients had one medical and two nursing visits/month, and, if necessary, immed iate additional access to a physician or nurse. The mean daily cost pe r patient of long-term feeding via PEG was obtained by adding up the m ean daily costs per patient of the three items, and was compared with that of feeding via nasogastric tube, calculated in 11 patients using the same criteria. No procedure-related death nor periprocedural major or minor complications were observed. The 60-day mortality was 3/34. Seventeen patients were always seen on an outpatient basis and 8 were followed by our home-care unit; 9 outpatients shifted to home care dur ing the follow-up. The mean duration of PEG use was 180.5 days (range 47-639). Two wound infections, treated with antibiotics, occurred duri ng the follow-up. The mean daily costs of placement, nutrition and pat ient care were (Italian liras) L 2500, 24 510 and 1880 respectively (D eutschemarks: DM 2.08, 20.42 and 1.56), for a total mean daily cost of L 28,890 (DM 24.06), slightly higher than that of feeding via a nasog astric tube (L 27,340; DM 22.78). On the basis of the improved quality of life, as well as from the economic point of view, PEG can be consi dered the procedure of choice for enteral feeding of cancer patients, provided that a reasonably long survival can be expected.