Cost–effectiveness analysis of jejunostomy tube feeding versus conventional nutritional method in esophageal cancer: a retrospective case control study

Esophageal cancer is a research priority due to its invasive nature and poor prognosis. It ranks sixth in mortality among all forms of cancer and esophagectomy is the most conventional treatment. Jejunostomy tube feeding can reduce complications in patients and hospital costs. This study aimed to evaluate the cost-effectiveness of jejunostomy tube feeding, as opposed to the common nutritional method.

A retrospective case-control study was conducted at a teaching hospital in Iran in 2015. The sample of the study included 100 candidates for esophagectomy. In the case group (enteral), a Jejunostomy tube was inserted for 50 patients undergoing esophagectomy. The control group (parenteral) consisted of 50 patients undergoing esophagectomy without jejunostomy tube.  

The median oral intake was on the third day in the case group, with a shorter hospital stay (P=0.02) compared to the control group. The mean total costs of hospitalization per patient in the case group and in the control group were 2228 and 3666 US dollars, respectively. The cost-effectiveness ratio of the jejunostomy tube against the common nutritional method was about 40 US dollars per day of the median decrease in oral intake.  

According to our findings, jejunostomy tube is cost-effective and preferable to the common nutritional method with a decreased median of oral intake start day, a decreased span of hospitalization, fewer complications in the nutritional support of the patients undergoing esophagectomy, and finally, more comfort for patients. The decrease in the average length of stay in hospitals is also important from the point of view of policymaking. So, this method can be a cost-effective alternative to the common nutritional method.