A cost-utility analysis in patients receiving enteral tube feeding at home and in nursing homes

SummaryA cost-utility analysis was undertaken of enteral tube feeding (ETF) in patients with cerebrovascular accident (CVA). Mortality during ETF was established in nursing homes (n7007) or at home (n2888). Quality of life was measured (EuroQol) on a sub-sample (n25). Quality adjusted life years (QALYs) over 3 years and the cost/QALY were calculated. The cost/QALY (£1 = €1.482; 30/06/05) for patients receiving ETF at home was £12,817 (£10,351–£16,826 using 95% CI for quality of life) and insensitive to the frequency of home visits (50–150% of the average frequency; £11,851–£13,782), outcome of patients reverting to full oral feeding (0–100% survival; £11,023–£14,440), and computed outcome of a ‘control’ group not given ETF (0.125–0.25 year survival; £12,991–£14,006). The cost/QALY in nursing homes (£10,304–£68,064) varied depending on the state contribution to non-medical costs and is above and below the threshold (£30,000/QALY). The data suggest the cost-effectiveness of ETF in patients with CVA receiving ETF at home or in nursing homes, where the non-medical costs are paid privately, compares favourably with other interventions. The cost-effectiveness of ETF in nursing homes when the state pays all non-medical costs compares unfavourably with other treatments, raising economic, clinical, and ethical concerns.