<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0212-1611</journal-id>
<journal-title><![CDATA[Nutrición Hospitalaria]]></journal-title>
<abbrev-journal-title><![CDATA[Nutr. Hosp.]]></abbrev-journal-title>
<issn>0212-1611</issn>
<publisher>
<publisher-name><![CDATA[Grupo Arán]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0212-16112025000501039</article-id>
<article-id pub-id-type="doi">10.20960/nh.05553</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Five-day preoperative immunonutrition in patients undergoing major surgery for gastrointestinal cancer &#8212; A cost-effectiveness analysis under the Brazilian healthcare system perspective]]></article-title>
<article-title xml:lang="es"><![CDATA[Inmunonutrición preoperatoria durante 5 días en pacientes sometidos a cirugía mayor por cáncer gastrointestinal: un análisis de coste-efectividad desde la perspectiva del sistema de salud brasileño]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Filho]]></surname>
<given-names><![CDATA[Pedro E. P.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ravanini]]></surname>
<given-names><![CDATA[Guilherme A. G.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ribeiro-Pereira]]></surname>
<given-names><![CDATA[Ana C. P.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fahham]]></surname>
<given-names><![CDATA[Lucas]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fernandes]]></surname>
<given-names><![CDATA[Roberta A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pagliosa]]></surname>
<given-names><![CDATA[Victoria M. R.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rosenfeld]]></surname>
<given-names><![CDATA[Valeria A. S.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidade Federal do Estado do Rio de Janeiro (UNIRIO) Universidade Federal do Estado do Rio de Janeiro (UNIRIO) ]]></institution>
<addr-line><![CDATA[Rio de Janeiro ]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,ORIGIN Health ORIGIN Health ]]></institution>
<addr-line><![CDATA[São Paulo ]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Nestlé Health Science Nestlé Health Science ]]></institution>
<addr-line><![CDATA[São Paulo ]]></addr-line>
<country>Brazil</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2025</year>
</pub-date>
<volume>42</volume>
<numero>5</numero>
<fpage>1039</fpage>
<lpage>1046</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S0212-16112025000501039&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S0212-16112025000501039&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S0212-16112025000501039&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Objectives: this study aims to evaluate the cost-effectiveness of 5-day preoperative enteral or oral immunonutrition in patients undergoing major surgery for gastrointestinal cancer, under the Brazilian Unified Health System (Sistema Único de Saúde &#8211; SUS) perspective. A budget impact analysis was also performed.  Methods: a decision tree model was built to compare enteral or oral immunonutrition with the standard diet, considering a time horizon of 5 + 30 days. To determine the efficacy outcomes, studies using 5-day preoperative immunonutrition were retrieved from a previously published meta-analysis. New combined estimates for the occurrence of infectious complications, non-infectious complications, length of stay, and 30-day mortality were calculated using studies with a 5-day period intervention. Treatment strategies were compared using the incremental cost-effectiveness ratio (ICER). Costs were reported in Brazilian reals (BRL) and euros (EUR).  Results: results combined through the meta-analysis showed that the occurrence of infectious complications was 17.2 % (65/378) and 28.8 % (99/344) for the immunonutrition and the control group, respectively (OR = 0.46; 95 % CI = 0.28-0.78; p = 0.003). Considering total costs by procedure, estimates of 930.56 BRL/151.31 EUR (267.75 BRL/43.54 EUR due to immunonutrition and 662.81 BRL/107.77 EUR due to infectious complications management) and 1,109.29 BRL/180.37 EUR (0.0 BRL/EUR due to standard diet and 1,109.29 BRL/180.37 EUR due to infectious complications management) were observed for immunonutrition and standard diet groups, respectively. Cost-effectiveness analysis showed that immunonutrition reduced the occurrence of infectious complications (-12 %) with lower costs (-178.73 BRL/-29.06 EUR). Total savings over 5 years was approximately 5 million BRL/817,352 EUR.  Conclusion: 5-day preoperative enteral or oral immunonutrition not only has a positive clinical impact for patients undergoing major surgery for gastrointestinal cancer but can also generate substantial reductions in costs for SUS.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Objetivos: este estudio tiene como objetivo evaluar la relación coste-efectividad de la inmunonutrición enteral u oral preoperatoria durante 5 días en pacientes sometidos a cirugía mayor por cáncer gastrointestinal desde la perspectiva del Sistema Único de Salud (SUS) de Brasil. También se realizó un análisis del impacto presupuestario.  Métodos: se construyó un modelo de árbol de decisión para comparar la inmunonutrición enteral u oral con la dieta estándar, considerando un horizonte temporal de 5 + 30 días. Para determinar los resultados de eficacia, se recuperaron estudios que utilizaron inmunonutrición preoperatoria de 5 días a partir de un metaanálisis previamente publicado. Se calcularon nuevas estimaciones combinadas para la ocurrencia de complicaciones infecciosas, complicaciones no infecciosas, duración de la hospitalización y mortalidad a los 30 días utilizando estudios con una intervención de 5 días. Las estrategias de tratamiento se compararon utilizando la razón de coste-efectividad incremental (RCEI). Los costes se informaron en reales brasileños (BRL) y euros (EUR).  Resultados: los resultados combinados a través del metaanálisis mostraron que la ocurrencia de complicaciones infecciosas fue del 17,2 % (65/378) y del 28,8 % (99/344) para el grupo de inmunonutrición y el grupo de control, respectivamente (OR = 0,46; IC 95 % = 0,28-0,78; p = 0,003). Al considerar los costes totales por procedimiento, se observaron estimaciones de 930,56 BRL/151,31 EUR (267,75 BRL/43,54 EUR debido a la inmunonutrición y 662,81 BRL/107,77 EUR debido al manejo de complicaciones infecciosas) y 1.109,29 BRL/180,37 EUR (0,0 BRL/EUR debido a la dieta estándar y 1.109,29 BRL/180,37 EUR debido al manejo de complicaciones infecciosas) para los grupos de inmunonutrición y dieta estándar, respectivamente. El análisis de coste-efectividad mostró que la inmunonutrición redujo la ocurrencia de complicaciones infecciosas (-12 %) con costes más bajos (-178,73 BRL/-29,06 EUR). El ahorro total en 5 años fue de aproximadamente 5 millones de BRL/817.352 EUR.  Conclusión: la inmunonutrición enteral u oral preoperatoria durante 5 días no solo tiene un impacto clínico positivo para los pacientes sometidos a cirugía mayor por cáncer gastrointestinal, sino que también puede generar reducciones sustanciales en los costes para el SUS.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Cost-effectiveness analysis]]></kwd>
<kwd lng="en"><![CDATA[Immunonutrition diet]]></kwd>
<kwd lng="en"><![CDATA[Gastrointestinal neoplasms]]></kwd>
<kwd lng="en"><![CDATA[Surgical procedures]]></kwd>
<kwd lng="en"><![CDATA[operative]]></kwd>
<kwd lng="es"><![CDATA[Análisis de coste-efectividad]]></kwd>
<kwd lng="es"><![CDATA[Dieta de inmunonutrición]]></kwd>
<kwd lng="es"><![CDATA[Neoplasias gastrointestinales]]></kwd>
<kwd lng="es"><![CDATA[Procedimientos quirúrgicos operativos]]></kwd>
</kwd-group>
</article-meta>
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