Economic Evaluation of Inhaled Nitric Oxide in Preterm Infants Undergoing Mechanical Ventilation

Zupancic, John A.F.; Hibbs, Anna Maria; Palermo, Lisa; Truog, William E.; Cnaan, Avital; Black, Dennis M.; Ballard, Philip L.; Wadlinger, Sandra R.; Ballard, Roberta A.

doi:10.1542/peds.2008-3214

Cited by 30 publications

(22 citation statements)

References 18 publications

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“…8 A retrospective economic evaluation using patient-level data from the NOCLD trial (the only trial showing clinical benefit) reported that the overall mean cost per infant for the initial hospitalization was similar in the treated and placebo groups; however, when iNO therapy was initiated between 7 and 14 days of age, there was a 71% probability that the treatment decreased costs and improved outcomes. 45 Cost-benefit analysis from 2 other studies failed to show any costbenefit. 37,39 Among preterm infants in the Inhaled Nitric Oxide Versus Ventilatory Support Without Inhaled Nitric Oxide trial, there was no difference in resource use and cost of care through the 4-year assessment.…”

Section: Cost-benefit Analyses Of Routine Use Of Ino In Preterm Infantsmentioning

confidence: 99%

Use of Inhaled Nitric Oxide in Preterm Infants

Kumar¹,

Papile²,

Polin³

et al. 2014

Pediatrics

122

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Nitric oxide, an important signaling molecule with multiple regulatory effects throughout the body, is an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn and hypoxemic respiratory failure. Several randomized controlled trials have evaluated its role in the management of preterm infants ≤34 weeks' gestational age with varying results. The purpose of this clinical report is to summarize the existing evidence for the use of inhaled nitric oxide in preterm infants and provide guidance regarding its use in this population. Pediatrics 2014;133:164-170 INTRODUCTIONNitric oxide (NO) is an important signaling molecule with multiple regulatory effects throughout the body. In perinatal medicine, inhaled nitric oxide (iNO) was initially studied for its pulmonary vasodilating effects in infants with pulmonary hypertension and has since become an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn and hypoxemic respiratory failure. 1 Inhaled NO also has multiple and complex systemic and pulmonary effects. In animal models of neonatal chronic lung disease, iNO stimulates angiogenesis, augments alveolarization, improves surfactant function, and inhibits proliferation of smooth muscle cells and abnormal elastin deposition. [2][3][4][5][6] Although the evidence for similar benefits in preterm infants is lacking, the off-label use of iNO in this population has escalated. 7 A study published in 2010 reported a sixfold increase (from 0.3% to 1.8%) in the use of iNO among infants born at less than 34 weeks' gestation between 2000 and 2008. 7 The greatest increase occurred among infants who were born at 23 to 26 weeks' gestation (0.8% to 6.6%). The National Institutes of Health convened a consensus panel in October 2010 to evaluate the evidence for safety and efficacy of iNO therapy in preterm infants. After reviewing the published evidence, the panel concluded that the available evidence does not support the use of iNO in early routine, early rescue, or later rescue regimens in the care of infants born at less than 34 weeks' gestation and that hospitals, clinicians, and the pharmaceutical industry should avoid marketing iNO for this group of infants. 8 An individual-patient data meta-analysis of 14 randomized controlled trials reached similar conclusions. 9 The purpose of this clinical report is to summarize the Praveen Kumar MD, FAAP, and COMMITTEE ON FETUS AND NEWBORN KEY WORDS inhaled nitric oxide, preterm infants, hypoxic respiratory failure, bronchopulmonary dysplasia ABBREVIATIONS BPD-bronchopulmonary dysplasia iNO-inhaled nitric oxide NO-nitric oxide NOCLD-Nitric

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Section: Cost-benefit Analyses Of Routine Use Of Ino In Preterm Infantsmentioning

confidence: 99%

Use of Inhaled Nitric Oxide in Preterm Infants

Kumar¹,

Papile²,

Polin³

et al. 2014

Pediatrics

122

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“…Unfortunately, such evaluations are uncommon in neonatology, constituting only 1% of RCTs in 1 systematic review. 47 When they have been performed, they have confirmed that expensive therapies may represent good Value, 28,48,49 and that economic outcomes might facilitate decision-making when clinical outcomes are equivalent. 50 To perform economic evaluation ancillary to RCTs or other clinical studies, additional data are necessary.…”

Section: Evidence-based Economicsmentioning

confidence: 97%

“…Existing guidelines provide a roadmap for investigators on how to perform such analyses. 20,51,52 When prospective economic evaluation alongside an RCT is infeasible, cost-effectiveness can be assessed in retrospective analyses of RCT data, 22,49,53 decision analysis by using RCT efficacy information, 54 or carefully performed observational investigations. 55 Similar concern for bias exists for economic evaluations as for efficacy outcome when there is a lack of randomization and an a priori hypothesis.…”

Section: Evidence-based Economicsmentioning

confidence: 99%

Evidence, Quality, and Waste: Solving the Value Equation in Neonatology

et al. 2016

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Rising health care costs challenge governments, payers, and providers in delivering health care services. Tremendous pressures result to deliver better quality care while simultaneously reducing costs. This has led to a wholesale re-examination of current practice methods, including explicit consideration of efficiency and waste. Traditionally, reductions in the costs of care have been considered as independent, and sometimes even antithetical, to the practice of high-quality, intensive medicine. However, it is evident that provision of evidence-based, locally relevant care can result in improved outcomes, lower resource utilization, and opportunities to reallocate resources. This is particularly relevant to the practice of neonatology. In the United States, 12% of the annual birth cohort is affected by preterm birth, and 3% is affected by congenital anomalies. Both of these conditions are associated with costly health care during, and often long after, the NICU admission. We will discuss how 3 drivers of clinical practice in neonatal care (evidence-based medicine, evidence-based economics, and quality improvement) can together optimize clinical and fiscal outcomes.

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“…This fact could reduce the feasibility of iNO in developing countries. However, other authors have recently evaluated a population of infants with a gestational age of less than 34 weeks, analyzing the length of hospitalization and ventilation, asserting that iNO is not associated with higher costs of care while improving outcomes [30], conflicting with the findings of the INNOVO study performed on a similar population [31]. The differences reported in published studies ( variables evaluated, making unfeasible any prediction concerning the real cost of the treatment.…”

Section: Nitric Oxyde (No)mentioning

confidence: 98%

Current Applications of Therapeutic Gases in Neonatal Intensive Care

Migliori¹,

Garzoli²,

Chirico

2010

CPR

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Various gases are utilized in respiratory care. Though oxygen is the most frequently administered, the use of other gases has become common practice in recent years. This report reviews the literature concerning some of the therapeutic gases utilized in Neonatal Intensive Care Unit (NICU). Inhaled Nitric Oxide is a selective pulmonary vasodilator largely employed in the Intensive Care Units. Its effects are well known as well as cost/effectiveness and consequently limitations, mainly in the developed countries. An alternative gas with comparable characteristics is Onitrosoethanol. In experimental studies, this gas seems to improve oxygenation and systemic haemodynamics, reducing the rebound hypoxaemia and the production of toxic by-products. Helium-oxygen mixture is less common, although it is widely known to both the decrease the pressure required to ventilate the lung and the resistive work of breathing, improving gas exchange in particular clinical conditions. Recent studies showed its efficacy and feasibility both in infants and in preterms. Carbon dioxide is usually employed for the management of some specific congenital heart defects characterised by various grades of pulmonary vascular resistance. Its major effect is the reduction of pulmonary blood flow to decrease cardiac work. The Xenon, already known for its anaesthetic proprieties although rarely used, has recently been considered for neuroprotection, opening a new field of interest in neonatal hypoxia/ischemia syndrome.

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Economic Evaluation of Inhaled Nitric Oxide in Preterm Infants Undergoing Mechanical Ventilation

Cited by 30 publications

References 18 publications

Use of Inhaled Nitric Oxide in Preterm Infants

Use of Inhaled Nitric Oxide in Preterm Infants

Evidence, Quality, and Waste: Solving the Value Equation in Neonatology

Current Applications of Therapeutic Gases in Neonatal Intensive Care

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