Cost-Effectiveness of Early Oral Feeding Following Total Gastrectomy
Bibliographic record
Abstract
BACKGROUND: Gastric cancer is a major health problem worldwide. Effectiveness of early oral feeding (EOF) following gastrectomy has been internationally evaluated, even though there is limited evidence available. In Japan, recently, a randomized controlled trial of EOF following total gastrectomy showed a decreased length of hospital stay, compared with conventional oral feeding (COF). To evaluate value for money of EOF following gastrectomy, cost-effective analysis was carried out based on this trial. METHODS: The analysis was carried out from a societal perspective as the base case. The subjects were randomly assigned to the EOF group (N=32) and the COF group (N=30). While the EOF group received a special diet (i.e., iEAT) from the postoperative day (POD) 1 to POD 3, the COF group received conventional diet (i.e., a liquid diet or rice gruel) on POD 4 and thereafter. The observation period was 3 weeks after total gastrectomy. As an effectiveness measure, quality-adjusted life days (QALDs) were estimated. Quality of life for health conditions was evaluated by using EuroQol-5Dimentions (EQ-5D)-3Levels among the subjects. Costs (e.g., nutritional support, hospitalization and treatment of adverse events) were estimated from trial data during observation. Qualitative and stochastic sensitivity analyses were performed to examine the robustness of the results. RESULTS: The mean QALDs per patient for the EOF and the COF groups were 14.93 and 14.19, respectively. Incremental effectiveness of the EOF group to the COF group was 0.74 QALDs (p=0.359, t-test). The mean total cost per patient in the EOF and the COF groups was $3,177.7 and $3,755.4, respectively. Incremental cost was -$577.7 (p=0.03, t-test, Welch). This means EOF is dominant (cost saving). The qualitative sensitivity analysis and the stochastic sensitivity analysis showed the relative robustness of these results. CONCLUSIONS: Economic evaluation of EOF following total gastrectomy showed that EOF was cost-saving, with non-significant increase in effectives (i.e., QALD), compared with COF. This result can contribute to strengthen the evidence for wide use of EOF.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".