Economic analysis of partially hydrolyzed guar gum (PHGG) for the treatment of patients receiving enteral nutrition

Summary: Background & Aims: Diarrhea is very common in patients receiving enteral nutrition. The principle of diarrhea treatment involves implementing dietary modifications, such as reduction of the fatty component, oral and probiotic supplementations, and increase of the fiber intake, aimed at mitigating the frequency and intensity of symptoms. In this context, partially hydrolyzed guar gum (PHGG) has emerged as a potential soluble fiber maximizing the effect against GI symptoms, particularly diarrhea. Among PHGG, NOVASOURCE® GI Control is an enteral nutrition formula indicated to improve the nutritional status and intestinal symptoms in patients with (risk of) malnutrition and intestinal barrier dysfunction, or intolerance to enteral nutrition. The objective of this economic analysis was to compare costs and effects of PHGG diet (taken with NOVASOURCE® GI Control) vs standard diet (SD, without fibers), in patients who are in need of enteral nutrition, in Italy. Methods: Two different analyses were conducted to reflect the most typical settings where enteral nutrition is relevant: i) critically-ill patients admitted to the hospital for an acute, life-threatening condition; ii) medical or (post)surgical patients. A simple decision-tree analysis was developed, with some minor differences depending on the setting. Hospital perspective was used to evaluate PHGG cost-opportunity in the hospital for critically-ill patients setting, while the Italian National Health Service (NHS) to assess the product for medical or surgical patients, assuming they were predominantly treated in an outpatient setting. Health outcomes and costs of critically-ill hospitalized patients and medical or surgical patients treated in a healthcare facility were estimated over a time horizon of 20 (PHGG group) to 27 (SD arm) days and over 24 days, respectively. Results: In the critically-ill setting, the use of PHGG diet prevented ∼12 cases of diarrhea every N=100 cases treated (relative reduction: -35%). The higher acquisition costs needed for PHGG diet (+€2,992) were more than offset by savings in all the other cost items, such as costs of hospital stay, medical therapy, costs of consumables, and cost of professional care to manage diarrhea (total saving -€1,186,330). Similarly, in medical or surgical patients, the use of PHGG was found cost-saving vs SD (-€6,040), and also reduced the number of diarrhea cases (relative reduction: -60%). Conclusions: The conducted economic analysis provides confidence that PHGG is a valuable and economically sustainable asset. Its utilization ensures not only adequate nutrition but also proves effective in mitigating diarrhea, thereby improving quality of life and limiting complication costs.