Home parenteral nutrition: a systematic review

Richards D M, Deeks J J, Sheldon T A, Shaffer J L
Record ID 31998008903
Authors' objectives:

The objective was to locate, appraise and summarise evidence from scientific studies on home parenteral nutrition (HPN) in order to answer the following specific research questions:

What patients have received HPN?

What has been the experience of patients on HPN programmes?

How have HPN programmes been organised, and what techniques and equipment have been used, and to what effect?

What comparative information is available on effectiveness?

What evidence exists for the cost-effectiveness of HPN?

What questions about the provision of HPN could be answered with additional research, and what studies would be most suitable?

Authors' results and conclusions: The age and sex of patients on HPN varies according to the underlying disease but, on the whole, patients are young. There are trends showing an increased use of the technology at the extremes of the age range. There are marked differences between countries on the underlying diseases for which HPN is indicated. For example, many more patients with an underlying malignancy are treated in Italy and the USA than in the UK (40 67% versus 8%). Morbidity rates for the majority of patients are acceptable, the complications tend to be related to the central venous catheter. It is fairly clear that a minority of patients are susceptible to recurrent problems and that many patients have very few complications. The mortality rate for HPN patients was good for those patients with benign underlying disease (for example, 5% of Crohn's HPN patients die per year), and there are very few reports of patients dying from complications of the technology. The survival of those with malignant disease and AIDS is poor, almost all having died from the underlying disease at one year; despite this, most programme growth worldwide is due to an increase in the numbers of patients with these diagnoses. Quality of life is reasonable for patients with benign disease; no studies were found that examined the quality of life of HPN patients with malignant disease. There is a paucity of comparative studies examining different aspects of the technology, and this accounted for the majority of gaps in the evidence.
Authors' recommendations: The use of HPN for benign intestinal failure is supported by evidence from the scientific studies located. There are, however, large gaps in the evidence, particularly relating to the use of HPN in malignant disease and AIDS.
Authors' methods: Systematic review
Project Status: Completed
URL for project: http://www.hta.ac.uk/922
Year Published: 1997
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Costs and Cost Analysis
  • Parenteral Nutrition, Home
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: 2009 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.