Systematic review and cost‐utility of high flow nasal cannula versus continuous positive airway pressure in children with acute severe or moderate bronchiolitis in Colombia

Abstract

Background: Nasal Continuous Positive Airway Pressure (CPAP) and High-Flow Nasal Cannula (HFNC) have emerged as alternatives to orotracheal intubation and conventional invasive ventilation in patients with moderate to severe bronchiolitis.This study aims to evaluate the evidence and the cost-utility of HFNC compared to CPAP in infants with moderate-severe bronchiolitis in Colombia. Methods:The search includes electronic databases such as Pubmed, ScienceDirect, and Embase. Through inclusion and exclusion criteria, screen randomized controlled trials. A decision tree model was used to estimate the cost-utility of CPAP compared with HFNC in infants with moderate-severe bronchiolitis. Sensitivity analysis of transition probabilities, utilities, and cost was carried out.Results: Incorporate five studies that meet the criteria. The risk of intubation rate in the patients with CPAP is lower than HFNC (relative risk 0.62; 95% confidence interval 0.46−0.84; I 2 = 0%) The base-case analysis showed that compared with HFNC, CPAP was associated with lower costs and higher quality-adjusted life years (QALYs). The expected annual cost per patient with CPAP was US$17,574 and with HFNC was US$29,421. The QALYs per person estimated with CPAP were 0.92 and with HFNC was 0.91. This position of absolute dominance of CPAP (CPAP has lower costs and higher QALYs than HFNI) makes it unnecessary to estimate the incremental cost-utility ratio.Conclusions: CPAP is cost-effective, over the HFNC, in infants with severemoderate bronchiolitis in Colombia. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other countries.

Critical care of severe bronchiolitis during shortage of ICU resources

“…Available data show that the ICU management of bronchiolitis, despite being expensive in absolute terms, consists of interventions that are likely to be cost-effective. 50 , 51 , 68 , 69 , 70 , 71 , 72 , 73 , 74 Data are summarised in Table 1 : this is not a formal cost-effectiveness analysis, since it is difficult to precisely assess some of these effects (e.g. the cost of inter-hospital transfer or the effects on families, which may vary according to several factors) and studies have different designs and outcomes.…”