Nutrición Hospitalaria 05553 / http://dx.doi.org/10.20960/nh.05553
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Trabajo Original

5-day preoperative immunonutrition in patients undergoing major surgery for gastrointestinal cancer: a cost-effectiveness analysis under the Brazilian healthcare system perspective


Pedro E. P. Filho, Guilherme A. G. Ravanini, Ana Carolina Padula Ribeiro-Pereira, Lucas Fahham, Roberta Arinelli Fernandes, Victoria M. R. Pagliosa, Valéria Abrahão Schilling Rosenfeld

Prepublicado: 2025-09-18

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OBJECTIVES: This study aims to evaluate the cost-effectiveness of 5-day preoperative enteral or oral immunonutrition in patients undergoing major surgery for gastrointestinal cancer, under the Brazilian Unified Health System (Sistema Único de Saúde – SUS) perspective. A budget impact analysis was also performed. METHODS: A decision tree model was built to compare enteral or oral immunonutrition with the standard diet, considering a time horizon of 5+30 days. To determine the efficacy outcomes, studies using 5-day preoperative immunonutrition were retrieved from a previously published meta-analysis. New combined estimates for the occurrence of infectious complications, non-infectious complications, length of stay, and 30-day mortality were calculated using studies with a 5-day period intervention. Treatment strategies were compared using the incremental cost-effectiveness ratio (ICER). Costs were reported in Brazilian Real (BRL) and Euros (EUR). RESULTS: Results combined through the meta-analysis showed that the occurrence of infectious complications was 17.2% (65/378) and 28.8% (99/344) for the immunonutrition and the control group, respectively (OR=0.46; 95% CI=0.28-0.78; p=0.003). Considering total costs by procedure, estimates of 930.56BRL/151.31EUR (267.75BRL/43.54EUR due to immunonutrition and 662.81BRL/107.77EUR due to infectious complications management) and 1,109.29BRL/180.37EUR (0.0BRL/EUR due to standard diet and 1,109.29BRL/180.37EUR due to infectious complications management) were observed for immunonutrition and standard diet groups, respectively. Cost-effectiveness analysis showed that immunonutrition reduced the occurrence of infectious complications (-12%) with lower costs (-178.73BRL/-29.06EUR). Total savings over 5 years was approximately 5 million BRL/817,352EUR. CONCLUSION: 5-day preoperative enteral or oral immunonutrition not only has a positive clinical impact for patients undergoing major surgery for gastrointestinal cancer but can also generate substantial reductions in costs for SUS.

Palabras Clave: Cost-Effectiveness Analysis; Immunonutrition Diet; Gastrointestinal Neoplasms; Surgical Procedures, Operative.



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