Introduction: Key determinants of costs associated with home parenteral nutrition (HPN) among patients with short bowel syndrome (SBS) are unknown. The aim of this analysis was to examine how charges associated with HPN relate to residual bowel anatomy.

Methods: We conducted a retrospective cohort analysis of medical history and charges for patients with SBS treated at a large Danish referral center. Clinical characteristics for SBS patients from 2006-2016 were obtained from a longitudinal database (LD). Charges assigned to patients for transport, PN, drugs, admissions, and ambulatory care visits were available from hospital databases for the year 2011. The LD contained 210 patients, while the 2011 sample contained a subset of 105 patients. For this analysis, we focused on patients with jejunostomies and ileostomies (2011 n=79). Charges are reported in Danish Kroner (DKK). We used linear regression to assess the relationship between anatomy (length of remaining bowel in cm) and 2011 charges.

Results: Patients in both the 2011 cohort and LD averaged 6.5 days of HPN per week. The 2011 sample had an average of 283 HPN days per year (275 in LD), and an average of 5.27 years since HPN initiation (5.9 years in LD). Patients in 2011 received an average 2690.6 mL of HPN fluids per day (2803.8 mL in LD). Sample characteristics were similar across demographic and disease characteristics when comparing 2011 patients to the LD of patients in the 10-year cohort. Among patients with jejunostomies and ileostomies, those with the most severe SBS had higher charges compared to those with greater length of residual bowel. Linear regression demonstrated a significant relationship (b=-82657, p<0.001) between anatomy type and total annual charges, with decreasing remnant bowel length resulting in increasing charges

Conclusion: This study aimed to evaluate costs associated with caring for SBS patients while considering 5 main factors – HPN, hospital admission, ambulatory care visits, transport, and drugs. Our data indicate a linear inverse relation between residual bowel anatomy and costs of care. The potential impact of PN complications and their relation to anatomy merits further study. Improved understanding of these costs will allow more nuanced cost benefit analysis of emerging novel treatments that may allow some patients to be partially weaned off PN.