Original Article Usefulness of the daily defined dose method to estimate trends in the consumption, costs and prevalence of the use of home enteral nutrition Gabriel Olveira a, b, * , Marı ´a Jose ´ Tapia a , Natalia Colomo a , Antonio Mun ˜oz a , Montserrat Gonzalo a , Federico C-Soriguer a, b a Unidad de Nutricio ´n Clı ´nica y Diete´tica, Servicio de Endocrinologı ´a y Nutricio ´n, Hospital Regional Universitario Carlos Haya, Ma ´laga, Spain b CIBERDEM CIBER de Diabetes y Enfermedades Metabo ´licas Asociadas, Spain article info Article history: Received 9 November 2008 Accepted 11 February 2009 Keywords: Prevalence Enteral nutrition Costs Oral supplements Defined daily dose Diabetes summary Background & aims: To analyse the trends in consumption and costs of home enteral nutrition (HEN) products in Andalusia (Spain) and estimate the prevalence of HEN from 2000 to 2007. Methods: Using the defined daily dose (DDD) method, we assigned a DDD to each type of diet, grouped as whole diets, supplements, modules and thickeners. The number of cases/10 6 inhabitants/day (CID) was calculated. Results: The number of persons receiving HEN rose notably, from 66.4 CID in 2000 to 1315.4 in 2007. The number of persons with home enteral tube feeding has remained stable since 2003, at around 220 CID. HEN with oral nutritional supplements (ONS) increased exponentially, with a prevalence of 910 CID in 2007. The prevalence of HEN in 2007 was similar to that of other European countries. The costs asso- ciated with HEN rose from 1.3 million euros in 2000 to over 37 million euros in 2007, due to the progressive increase in the number of persons being prescribed HEN, especially ONS, and the incorpo- ration of more expensive organ-specific formulas. Conclusions: DDD is useful to indirectly estimate the prevalence of HEN and evaluate long-term trends in the prescription and costs of various HEN products. Ó 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. 1. Introduction Home artificial nutrition in the form of home enteral nutrition (HEN) and home parenteral nutrition (HPN) has grown rapidly in some countries over the last 30 years, accompanied by technolog- ical advances in central venous catheters, enteral nutrition tubes, organ-specific formulations and infusion pumps, together with adequate follow-up programs. 1–4 Nevertheless, major international and regional differences still exist in the prevalence and growth rate of home artificial nutrition, in the organisation of nutritional support services, and in financial arrangements. The origins of HEN are much older than those of HPN and date back centuries; but even so, statistical information about HEN is less reliable than for HPN, despite the much greater use of the former. This is partly because in many countries HEN is initiated and coordinated from many centres compared with the small number of specialist centres dealing with HPN. The lack of national registers in most European countries makes accumulation of data even more difficult. Furthermore, there is little agreement about what constitutes HEN. While in some countries only home enteral tube feeding (HETF) is considered as enteral nutrition, in other countries (for example, Spain) both oral tube feeding and oral nutritional supplements (ONS) are also considered to be forms of home enteral nutrition. 2,3,5 Accordingly, the true prevalence of HEN in Europe is unknown and only reliable in a few publications. 3,4 The latest data from the 2006 HEN registry in Spain show the prevalence to be 100 cases per million inhabitants, 6 including via oral, a figure that is clearly lower than the expected figure and which reflects the lack of precision of the data due to the fact that they depend on the voluntary reporting of cases. In 1969 the WHO organised a symposium where data were presented on the consumption of drugs in various European countries. However, adequate comparison of the information between the countries was not possible, as this was presented in Abbreviations: HEN, home enteral nutrition; HPN, home parenteral nutrition; HETF, home enteral tube feeding; ONS, oral nutritional supplements; DDD, defined daily dose; CID, cases/10 6 inhabitants/day; CDNU, clinical and dietary nutrition units. * Corresponding author. Unidad de Nutricio ´ n y Diete ´ tica, 4 a Planta, Pabello ´n A, Hospital Regional Universitario Carlos Haya, Avda. Carlos Haya, S/N 29010 Malaga, Spain. Tel./fax: þ34 952 28 67 04. E-mail addresses: gabrielm.olveira.sspa@juntadeandalucia.es, olveiradiaz@ golveira.jazztel.es (G. Olveira). Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://intl.elsevierhealth.com/journals/clnu 0261-5614/$ – see front matter Ó 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2009.02.007 Clinical Nutrition 28 (2009) 285–290