First-line oxygen therapy with high-flow in bronchiolitis is not cost saving for the health service.

Australia / epidemiology Bronchiolitis / economics Cost Savings Humans Hypoxia / therapy Infant Infant, Premature Length of Stay / economics New Zealand / epidemiology Oxygen Inhalation Therapy / economics Randomized Controlled Trials as Topic
costing health economics intensive care respiratory

Journal

Archives of disease in childhood
ISSN: 1468-2044
Titre abrégé: Arch Dis Child
Pays: England
ID NLM: 0372434

Informations de publication

Date de publication:
10 2020
Historique:
received: 22 10 2019
revised: 18 03 2020
accepted: 19 03 2020
pubmed: 12 4 2020
medline: 15 12 2020
entrez: 12 4 2020
Statut: ppublish

Résumé

Bronchiolitis is the most common reason for hospital admission in infants. High-flow oxygen therapy has emerged as a new treatment; however, the cost-effectiveness of using it as first-line therapy is unknown. To compare the cost of providing high-flow therapy as a first-line therapy compared with rescue therapy after failure of standard oxygen in the management of bronchiolitis. A within-trial economic evaluation from the health service perspective using data from a multicentre randomised controlled trial for hypoxic infants (≤12 months) admitted to hospital with bronchiolitis in Australia and New Zealand. Intervention costs, length of hospital and intensive care stay and associated costs were compared for infants who received first-line treatment with high-flow therapy (early high-flow, n=739) or for infants who received standard oxygen and optional rescue high-flow (rescue high-flow, n=733). Costs were applied using Australian costing sources and are reported in 2016-2017 AU$. The incremental cost to avoid one treatment failure was AU$1778 (95% credible interval (CrI) 207 to 7096). Mean cost of bronchiolitis treatment including intervention costs and costs associated with length of stay was AU$420 (95% CrI -176 to 1002) higher per infant in the early high-flow group compared with the rescue high-flow group. There was an 8% (95% CrI 7.5 to 8.6) likelihood of the early high-flow oxygen therapy being cost saving. The use of high-flow oxygen as initial therapy for respiratory failure in infants with bronchiolitis is unlikely to be cost saving to the health system, compared with standard oxygen therapy with rescue high-flow.

Sections du résumé

BACKGROUND
Bronchiolitis is the most common reason for hospital admission in infants. High-flow oxygen therapy has emerged as a new treatment; however, the cost-effectiveness of using it as first-line therapy is unknown.
OBJECTIVE
To compare the cost of providing high-flow therapy as a first-line therapy compared with rescue therapy after failure of standard oxygen in the management of bronchiolitis.
METHODS
A within-trial economic evaluation from the health service perspective using data from a multicentre randomised controlled trial for hypoxic infants (≤12 months) admitted to hospital with bronchiolitis in Australia and New Zealand. Intervention costs, length of hospital and intensive care stay and associated costs were compared for infants who received first-line treatment with high-flow therapy (early high-flow, n=739) or for infants who received standard oxygen and optional rescue high-flow (rescue high-flow, n=733). Costs were applied using Australian costing sources and are reported in 2016-2017 AU$.
RESULTS
The incremental cost to avoid one treatment failure was AU$1778 (95% credible interval (CrI) 207 to 7096). Mean cost of bronchiolitis treatment including intervention costs and costs associated with length of stay was AU$420 (95% CrI -176 to 1002) higher per infant in the early high-flow group compared with the rescue high-flow group. There was an 8% (95% CrI 7.5 to 8.6) likelihood of the early high-flow oxygen therapy being cost saving.
CONCLUSIONS
The use of high-flow oxygen as initial therapy for respiratory failure in infants with bronchiolitis is unlikely to be cost saving to the health system, compared with standard oxygen therapy with rescue high-flow.

Identifiants

DOI: 10.1136/archdischild-2019-318427 PMID: 32276987
pubmed: 32276987
pii: archdischild-2019-318427
doi: 10.1136/archdischild-2019-318427
doi:

Types de publication

Comparative Study Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

975-980

Informations de copyright

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: LS, SC and VSG report no conflict of interest relevant to this article to disclose. JAW, JFF, JN and EO report grants from the National Health Medical Research Council (NHMRC) Australia during the conduct of the study. DF, JFF, JN, EO and AS report equipment support for the study from the Fisher & Paykel Healthcare, Auckland. JFF and AS report Queensland Health Medical Research Fellowship. FEB reports grants from the NHMRC Australia, RCH Foundation and Melbourne Campus Clinician Scientist Fellowship. DF and AS report grants from the NHMRC Australia, Queensland Emergency Medical Research Fund, Ipswich Hospital Foundation and Gold Coast Hospital Foundation. DF, JFF and AS report travel support from the Fisher & Paykel Health Care, Auckland.

Auteurs

Vijay S Gc (VS)

Centre for Health Economics, University of York, York, UK.
Norwich Medical School, University of East Anglia, Norwich, UK.
ORCID: 0000-0003-0365-2605

Donna Franklin (D)

Paediatric Critical Care Research Group, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia.
Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.
The University of Queensland Child Health Research Centre, School of Medicine, Brisbane, Queensland, Australia.
Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.
Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
ORCID: 0000-0003-1650-3270

Jennifer A Whitty (JA)

Norwich Medical School, University of East Anglia, Norwich, UK.

Stuart R Dalziel (SR)

Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.
Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.

Franz E Babl (FE)

Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.
Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
ORCID: 0000-0002-1107-2187

Luregn J Schlapbach (LJ)

Paediatric Critical Care Research Group, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia.
Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.
The University of Queensland Child Health Research Centre, School of Medicine, Brisbane, Queensland, Australia.
Department of Paediatrics, Bern University Hospital, University of Bern, Bern, Switzerland.
ORCID: 0000-0003-2281-2598

John F Fraser (JF)

The University of Queensland Child Health Research Centre, School of Medicine, Brisbane, Queensland, Australia.
Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.
Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.

Simon Craig (S)

Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.
Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
ORCID: 0000-0003-2594-1643

Jocelyn Neutze (J)

Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.
KidzFirst Middlemore Hospital and theUniversity of Auckland, Auckland, New Zealand.

Ed Oakley (E)

Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.
Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.

Andreas Schibler (A)

Paediatric Critical Care Research Group, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia a.schibler@uq.edu.au.
Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.
The University of Queensland Child Health Research Centre, School of Medicine, Brisbane, Queensland, Australia.
Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.

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Classifications MeSH

questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Bronchite › Bronchiolite › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › Organisations et économie des soins de santé › Économie › Coûts et analyse des coûts › Maîtrise des coûts › Économies › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Signes et symptômes respiratoires › Hypoxie › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Prématuré › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Nouvelle-Zélande › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Oxygénothérapie › First-line oxygen therapy with high-flow in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › First-line oxygen therapy with high-flow in...