Cost-effectiveness analysis of tube feeding among older adults with advanced dementia in Japan: A net benefit regression approach

BACKGROUND: This study aims to assess the cost-effectiveness of percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) in older adults with advanced dementia, compared with non-artificial nutrition.

METHODS: Retrospective cohort study. Medical claims data and long-term care claims data from Fukuoka Prefecture, Japan, were used. We identified 3,882 older adults (≥75 years) with advanced dementia who were hospitalized between April 2016 and March 2019 due to dysphagia, malnutrition, or aspiration pneumonia. Using propensity score matching, we matched 192 patients in the PEG group with 192 in the non-artificial nutrition group, and 490 patients in the NGT group with 490 in the non-artificial nutrition group. We examined the survival years and total costs of each patient from the date of admission to March 31, 2020, and thereby estimated the cost-effectiveness of PEG and NGT, respectively, versus non-artificial nutrition. The net benefit regression model was employed to estimate the incremental net benefits (INB) with varying values of willingness-to-pay (WTP) for PEG and NGT. Furthermore, cost-effectiveness acceptability curve was used to present the probability of the cost-effectiveness of each intervention.

RESULTS: As WTP increased from JPY 7,747,909 (equivalent to US$51,546) to JPY 28,163,651 (equivalent to US$187,371), the probability of PEG being cost-effective increased from 50 % to nearly100 %. The NGT group had negative INB estimates.

CONCLUSIONS: Both PEG and NGT are less likely to provide economic values for patients with advanced dementia. However, this conclusion should be further refined through detailed cost-effectiveness analysis from multiple perspectives.