Approval of funding for preoperative carbohydrate 0.5kcal/ml oral feed (preOp) in DHB hospitals

Hospital devices

Decision

PHARMAC is pleased to announce the approval of a proposal to fund preoperative carbohydrate 0.5kcal/ml oral feed (preOp) in DHB hospitals from 1 August 2014 through an agreement with Nutricia Limited.

This proposal was the subject of a consultation letter dated 9 May 2014.

Details of the decision

  • Preoperative carbohydrate 0.5 kcal/ml oral feed (preOp) will be listed in Part II of Section H of the Pharmaceutical Schedule (Hospital Medicines List; HML) from 1 August 2014 at a price of $6.80 per 4 pack of 200 ml bottle (ex-manufacturer, excluding GST).
  • preOp will be listed on the HML from 1 August 2014 subject to the following restrictions

Oral feed 0.5 kcal/ml – Restricted
Maximum of 400 ml as part of an Enhanced Recovery After Surgery (ERAS) protocol 2 to 3 hours before major abdominal surgery

Feedback received

We appreciate all of the feedback that we received and acknowledge the time people took to respond. All consultation responses received were considered in their entirety in making a decision on the proposed changes. Most responses were supportive of the proposal, and the following issues were raised in relation to specific aspects of the proposal:

Theme Comment

Several responders requested that the restriction be widened to include other types of elective surgeries.

The Special Foods Subcommittee of PTAC did consider the use of a preoperative carbohydrate feed for other surgeries at its meeting in September 2013. Based on the evidence provided, the Subcommittee made the specific recommendation that this product should be funded for use only in major abdominal surgery, noting that majority of the data supported use in elective colorectal surgeries. The Subcommittee considered that the supportive care required for colorectal surgeries could be distinguished from other surgeries due to issues relating to ensuring that the gut was adequately healed after surgery. Minutes from this meeting can be found on the PHARMAC website [PDF, 24 KB].

We would welcome a funding application for preoperative carbohydrate feed for use in other surgeries, including details of the other surgeries the feed is requested for and supporting evidence for these uses. A link to the funding application form for clinicians and consumers is provided here. Applicants should expand the boxes as necessary and append full copies of relevant supporting information (for example, clinical trial publications and study reports).

Two responders requested that the restriction be widened to include a ‘loading dose’ of preoperative carbohydrate feed e.g. a further 200 ml 6 hours prior to surgery.

The Special Foods Subcommittee did consider the use of a pre-loading dose of carbohydrate solution, but considered that the evidence for the clinical effect of the carbohydrate on reducing insulin resistance was confined to a 50 g dose of oral carbohydrate received 2 hours before surgery and there appeared to be no additional benefit from doses given earlier than that. Further, the Subcommittee noted that current guidelines relating to general anaesthesia for elective surgery in healthy patients advise that generally, pre-operative patients would be able to consume carbohydrate in the form of normal diet up to 6 hours prior to surgery. Therefore this ‘loading dose’ is considered unnecessary. To clarify this, the restriction has been amended to indicate a maximum dosage to be used. Minutes from this meeting can be found on the PHARMAC website [PDF, 24 KB].

One responder requested that the restriction be amended to widen the timeframe of use to 2-3 hours before surgery (from the previous timeframe of 2 hours).

Following consideration of this feedback we have made this requested change and have extended the timeframe to 2-3 hours.

More information

If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 66 00 50.