The cost-utility of early use of high-flow nasal cannula in bronchiolitis

Abstract

Background High-flow nasal cannula (HFNC) oxygen is a non-invasive ventilation system that was introduced as an alternative to CPAP (continuous positive airway pressure), with a marked increase in its use in pediatric care settings. This study aimed to evaluate the cost-effectiveness of early use of HFNC compared to oxygen by nasal cannula in an infant with bronchiolitis in the emergency setting. Methods A decision tree model was used to estimate the cost-effectiveness of HFNC compared with oxygen by nasal cannula (control strategy) in an infant with bronchiolitis in the emergency setting. Cost data were obtained from a retrospective study on bronchiolitis from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. Results The QALYs per patient calculated in the base-case model were 0.9141 (95% CI 0.913–0.915) in the HFNC and 0.9105 (95% CI 0.910–0.911) in control group. The cost per patient was US$368 (95% CI US$ 323–411) in HFNC and US$441 (95% CI US$ 384–498) per patient in the control group. Conclusions HFNC was cost-effective HFNC compared to oxygen by nasal cannula in an infant with bronchiolitis in the emergency setting. The use of this technology in emergency settings will allow a more efficient use of resources, especially in low-resource countries with high prevalence of bronchiolitis .

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

“…For individual and collective decision‐making, having information on the efficiency of technology is an input of equal relevance to information about the safety or effectiveness of this intervention 4,24–30 . The use of interventions that allow us to gain the greatest quantity and quality of life at the lowest possible cost constitutes a priority in scenarios with unlimited resources as occur in developing countries 31,32 …”

High-flow nasal cannula for acute exacerbation of chronic obstructive pulmonary disease: a Cost-utility analysis

“…HFNC was found to dominate against standard oxygen and NIV when used in patients who had not previously been intubated and also when compared against standard oxygen in patients at low risk of re-intubation. We in a previous study estimated the cost-effectiveness of HFNC compared with oxygen by nasal cannula (control strategy) in an infant with bronchiolitis in the emergency setting (16). The cost per patient was US$368 (95% CI, US$ 323-411) in HFNC and US$441 (95% CI US$ 384-498) per patient in the control group.…”

“…Despite increased popularity as a treatment modality for respiratory support, there is still uncertainty about if the additional costs of this device justify the clinical benefits provided. In a previous paper, we demonstrated the cost-utility of this treatment in other diseases such as acute bronchiolitis with a favorable budgetary impact on the Colombian health system (15, 16). This would be significant, especially for hospitals in middle-income countries with scarce health resources, and where this technology could be a cost-saving alternative (17).…”

Systematic review and meta-analysis of efficacy and safety of continuous positive airways pressure versus high flow oxygen cannula in acute bronchiolitis

“…Also, our team recently found that HFNC, concerning conventional nasal cannula, was associated with a slight difference in the number of quality-adjusted life-years in favor of HFNC and with a saving of approximately US$72 per patient. These findings, if projected to the population level in Colombia for 5 years, could mean an estimated savings of US$13,166,071 if the HFNC is adopted for the routine management of all patients with moderate acute bronchiolitis [ 9 , 10 ]. When comparing HFNC vs. CPAP, the results of two recent systematic reviews are controversial.…”