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Published on: May 11, 2015
Cost-effectiveness of nasal high-flow in children with acute hypoxaemic respiratory failure
Brenda Gannon1,2, Donna Franklin3,4,5,6,7, Vinh Vo1
1School of Economics, University of Queensland, Brisbane, Queensland, Australia.
Insights
Nasal high-flow (NHF) therapy is not cost-effective as a first-line treatment for acute hypoxaemic respiratory failure in children. However, NHF may be cost-effective for non-obstructive patients requiring escalated care, with a willingness to pay over A$10,000 per reduced hospital day.
Area of Science:
- Pediatric Emergency Medicine
- Health Economics
- Respiratory Care
Background:
- Acute hypoxaemic respiratory failure (AHRF) in children presents a significant clinical challenge.
- Standard oxygen therapy (SOT) is the conventional treatment, but its effectiveness and cost-efficiency are areas for continued research.
- Nasal high-flow (NHF) therapy is an emerging alternative for respiratory support.
Purpose of the Study:
- To assess the cost-effectiveness of early NHF therapy compared to SOT in pediatric patients with AHRF.
- To estimate the impact of NHF on therapy escalation and hospital length of stay.
- To analyze cost-effectiveness across different patient subgroups based on airway obstruction and response to treatment.
Main Methods:
- A pilot randomized controlled trial (RCT) was conducted alongside a health economic analysis.
- A decision tree model was developed from a healthcare sector perspective.
- Cost-effectiveness was measured by incremental cost per length of hospital stay avoided, using bootstrapping for parameter uncertainty.
Main Results:
- NHF therapy resulted in an additional cost of A$367.20 with a shorter hospital stay for non-obstructive, non-responder patients.
- This subgroup was found to be cost-effective above a willingness-to-pay threshold of A$10,000.
- Other subgroups (obstructive/responder, non-obstructive/responder, obstructive/non-responder) showed increased costs and longer hospital stays, with the obstructive/non-responder group being significantly more expensive.
Conclusions:
- NHF therapy is unlikely to be cost-effective as a first-line treatment for AHRF in children compared to SOT.
- NHF demonstrates potential cost-effectiveness for non-obstructive patients who require escalation of care (non-responders).
- The cost-effectiveness for this specific subgroup is favorable if the willingness-to-pay exceeds A$10,000 per reduced hospital day.
Aim:
A pilot randomised controlled trial assessed the early application of nasal high-flow (NHF) therapy compared with standard oxygen therapy (SOT), in children aged 0 to 16 years presenting to paediatric emergency departments with acute hypoxaemic respiratory failure (AHRF). The study estimated the need to escalate therapy and hospital length of stay in the NHF group compared with SOT. This sub-study then assessed the subsequent cost-effectiveness.
Methods:
A decision tree-based model was developed, alongside the clinical study, to estimate cost-effectiveness, from the healthcare sector perspective. The primary health economics outcome is measured as incremental cost per length of hospital stay avoided. Incremental cost effectiveness ratios (ICER) measuring change in cost per change in length of stay, were obtained for four samples, depending on responder status and obstructive airways disease. These were (1) obstructive and responder, (2) non-obstructive and responder, (3) obstructive and non-responder and (4) non obstructive and non-responder. Bootstrapping of parameters accounted for uncertainty in estimates of cost and outcome.
Results:
The ICER for patients randomised to NHF, indicated an additional A$367.20 for a lower hospital length of stay (in days) in the non-obstructive/non-responder sample. In the bootstrap sample, this was found to be cost effective above a willingness to pay threshold of A$10 000. The ICER was A$440.86 in the obstructive/responder sample and A$469.56 in the non-obstructive/responder sample - but both resulted in a longer length of stay. The ICER in the obstructive/non-responder sample was A$52 167.76, also with a longer length of stay, mainly impacted by a small sample of severe cases.
Conclusion:
As first-line treatment, NHF is unlikely to be cost-effective compared with SOT, but for non-obstructive patients who required escalation in care (non-obstructive non-responder), NHF is likely to be cost-effective if willingness-to-pay per reduced hospital length of stay is more than A$10 000 per patient.
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