Healthcare cost of home parenteral nutrition and intestinal transplantation for paediatric chronic intestinal failure in Singapore

Background: Chronic intestinal failure (IF) and long-term parenteral nutrition (PN) impose significant financial burden on patients and the healthcare system. This study aimed to evaluate the healthcare cost of home-PN (HPN) and intestinal transplantation (ITx) at a single-centre. Methods: This was a cost-of-illness evaluation based on retrospective analysis of billing records of patients (0-18 years) receiving HPN in 2016-2025 (excluding hospital-PN). Annual HPN cost was calculated based on average cost during the latest 3 years of HPN. Cost of ITx (since 2022) included index hospitalisation for transplant surgery and all healthcare costs in the first 3 years following ITx (ITx-Y1/Y2/Y3). Results: Out of 35 patients with chronic IF, 11 patients on HPN with dysmotility(n = 6) and short bowel syndrome(n = 5) were included (median PN-duration: 6.5 years), with 4 eventually receiving ITx. Annual cost of HPN for patients who weaned-off HPN(n = 3), versus patients who remained stable on HPN(n = 3), and patients who developed complications from irreversible IF(n = 5) was S$70,227(US$51,638)/year, S$114,359(US$84,088)/year and S$219,510(US$161,404)/year respectively. Comparatively, mean cost of index hospitalisation for ITx was S$226,316(US$166,409). Cost was highest in ITx-Y1 (S$511,905/US$376,401), followed by 66-67 % year-on-year reduction to S$172,178(US$126,601) in ITx-Y2, and S$56,152(US$41,288) in ITx-Y3. Post-transplant lymphoproliferative disorder and cytomegalovirus infection contributed to wide variation in costs in ITx-Y1. Conclusions: Cost of HPN was highest in patients with irreversible IF. While ITx incurred the highest cost in ITx-Y1, there was substantial reduction in cost in the subsequent years, which may potentially be cost-saving in the long-term, as compared to continued HPN for patients with irreversible IF.