Economic investigation of the use of three-compartment total parenteral nutrition bag: prospective randomized unblinded controlled study

Optimal strategy for total parenteral nutrition (TPN) administration is ess ential both in terms of clinical effectiveness and economic efficiency. The aim of the present economic analysis was to provide a systematic and compr ehensive cost comparison of the application of three currently available TP N systems: Separate Bottles (SB), Hospital-Compounded Bags (HCB) and Three- Compartment Bags (TCB). Sixty patients, admitted to the Geneva University H ospital and requiring TPN, were randomly assigned to one of the three syste ms. Three standard TPN formulas were prescribed to meet the patients' prote in energy needs. TPN-related activities of medical, nursing and pharmacy st aff were timed for the 24 hours of TPN administration. Manpower, nutrient s olutions and medical supplies costs were calculated on the basis of mean Sw iss salaries and hospital prices. TCB was the least expensive TPN system. S B and HCB systems' application costs were 120 and 150% of TCB cost, respect ively. All intersystems cost comparisons were statistically significant (AN OVA p < 0.01). SB system required more items and manipulations, resulting i n higher nurses manpower cost. Pharmacy overhead cost due to compounding wa s responsible for the higher cost of HCB system. Detailed manpower data pre sented in this study allow for an estimation of TPN application costs in ot her hospitals, using local salaries, specific product prices and compoundin g costs. (C) 2000 Harcourt Publishers Ltd.