Background Parenteral nutrition (PN) is a costly technology used widely to provide nutrition to patients who have an inaccessible or non-functioning intestine. Two all-in-one systems currently being used are customised formulations, prepared by hospital pharmacies, and three-compartment bags.

Purpose To provide a systematic cost comparison of the two all-in-one PN systems: individualised (made from nutrient solutions) versus manufactured (made from three-compartment bag), both prepared in hospital pharmacies.

Materials and Methods We conducted a prospective study to analyse the total cost of PN bags, accounting for all of the processes involved in preparing and delivering them (the cost of manpower, nutrition solutions, medical supplies and quality controls) in three different healthcare settings. To compare therapeutic alternatives of equivalent nutritional value, the study was performed for the most frequently-employed formulation, which was similar to commercial preparations. A univariate sensitivity analysis was performed to evaluate the impact of different rates of use of three-compartment PN bags.

Results 157 routine acts of PN bag preparation (65 hospital compounded and 92 three-compartment) were observed and timed over 9 days. Total costs of the 157 PN bags were included in the study. Mean costs of hospital-compounded bags were higher than three-compartment bags, 51.16 ± 5.63€ versus 39.69 ± 3.00€ respectively (p < 0.01). Manpower costs were responsible for the majority of the differences found (70%). In scenarios using a three-compartment system for 30%, 70% and 90% of PN provision, a cost savings of 4.3%, 10.1% and 12.9% respectively could be achieved. Greatest rates of changing from hospital compounded bags (70% and 90%), in a hospital with 1,800 PN bags/year, might reduce the annual budget by 9306€ and 11,964.8€, respectively. Meanwhile, in a large facility the savings for 8,000 TPN days would be 64,248€ and 82,605€, respectively.

Conclusions Since we need to reduce the costs of effective treatments, three-compartment bags could be used for standard adult PN to save money.

No conflict of interest.