1019 Paediatric gastrostomy: where do the costs lie and how can we reduce them? – a systematic review
Bibliographic record
Abstract
Background Gastrostomy feeding to support nutrition in children is a common and effective undertaking. It is however, associated with significant costs both at creation of the gastrostomy and in maintaining the device in the long term. Given the widespread use of gastrostomies this creates a considerable financial burden for healthcare systems. Objectives This study aims to systematically review the existing literature to identify costs and potential cost reductions related to the insertion and maintenance of paediatric gastrostomy tubes (GT). Methods PubMed, MEDLINE and EMBASE were searched using PRISMA guidelines using the key words ‘paediatric’, ‘gastrostomy’ and ‘costs’. Inclusion criteria were studies assessing cost and/or possible cost reductions relating to paediatric GT. Exclusion criteria were studies: published before 2000, reporting a non-exclusively paediatric population, reporting the effect of GT combined with another procedure e.g. fundoplication. Two authors independently reviewed the title and abstract of identified articles against the inclusion criteria, inconsistencies were discussed and agreement on inclusion reached. Results A total of 212 studies were identified from the search strategy. After screening, 35 were included in the systematic review. Publication dates ranged from 2003–2020. Eight countries were included: USA (26/35), Canada and the United Kingdom (2 each) and Australia, Brazil, Turkey, France and Poland (1 each). Twelve papers discussed insertion, 14 enteral feeds, 11 complications, 10 ongoing healthcare costs and 3 patient education. Findings are summarised in the table. Conclusions This study provides a comprehensive review of the costs associated with GTs in children. Significant cost savings are possible at every point in the pathway of a patient with a GT. One-time cost savings are possible at insertion through the use of standardised protocols. The choice of device at insertion has both short- and long-term cost implications, the use of a primary balloon device offers cost savings over PEG devices. Longer term savings are possible through rationalising and protocolising feeds and medications. Patient education programs provide cost reductions through fewer hospital visits and have the potential to reduce tube use overall.
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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 | 0.011 | 0.045 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.007 |
| Bibliometrics | 0.012 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
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".