Emily Eaton Turner1, Michelle Jenks1. 1. a York Health Economics Consortium, Enterprise House, Innovation Way , University of York , York.
Abstract
OBJECTIVE: To estimate the cost-effectiveness of Nasal High Flow (NHF) in the intensive care unit (ICU) compared with standard oxygen or non-invasive ventilation (NIV) from a UK NHS perspective. METHODS: Three cost-effectiveness models were developed to reflect scenarios of NHF use: first-line therapy (pre-intubation model); post-extubation in low-risk, and high-risk patients. All models used randomized control trial data on the incidence of intubation/re-intubation, events leading to intubation/re-intubation, mortality and complications. NHS reference costs were primarily used. Sensitivity analyses were conducted. RESULTS: When used as first-line therapy, Optiflow™ NHF gives an estimated cost-saving of £469 per patient compared with standard oxygen and £611 versus NIV. NHF cost-savings for high severity sub-group were £727 versus standard oxygen, and £1,011 versus NIV. For low-risk post-intubation patients, NHF generates estimated cost-saving of £156 versus standard oxygen. NHF decreases the number of re-intubations required in these scenarios. Results were robust in most sensitivity analyses. For high-risk post-intubation patients, NHF cost-savings were £104 versus NIV. NHF results in a non-significant increase in re-intubations required. However, reduction in respiratory failure offsets this. CONCLUSIONS: For patients in ICU who are at risk of intubation or re-intubation, NHF cannula is likely to be cost-saving.
OBJECTIVE: To estimate the cost-effectiveness of Nasal High Flow (NHF) in the intensive care unit (ICU) compared with standard oxygen or non-invasive ventilation (NIV) from a UK NHS perspective. METHODS: Three cost-effectiveness models were developed to reflect scenarios of NHF use: first-line therapy (pre-intubation model); post-extubation in low-risk, and high-risk patients. All models used randomized control trial data on the incidence of intubation/re-intubation, events leading to intubation/re-intubation, mortality and complications. NHS reference costs were primarily used. Sensitivity analyses were conducted. RESULTS: When used as first-line therapy, Optiflow™ NHF gives an estimated cost-saving of £469 per patient compared with standard oxygen and £611 versus NIV. NHF cost-savings for high severity sub-group were £727 versus standard oxygen, and £1,011 versus NIV. For low-risk post-intubation patients, NHF generates estimated cost-saving of £156 versus standard oxygen. NHF decreases the number of re-intubations required in these scenarios. Results were robust in most sensitivity analyses. For high-risk post-intubation patients, NHF cost-savings were £104 versus NIV. NHF results in a non-significant increase in re-intubations required. However, reduction in respiratory failure offsets this. CONCLUSIONS: For patients in ICU who are at risk of intubation or re-intubation, NHF cannula is likely to be cost-saving.
Authors: Melissa Earwaker; Sofia Villar; Julia Fox-Rushby; Melissa Duckworth; Sarah Dawson; Jo Steele; Yi-da Chiu; Edward Litton; Gudrun Kunst; Gavin Murphy; Guillermo Martinez; Vasileios Zochios; Val Brown; Geoff Brown; Andrew Klein Journal: Trials Date: 2022-03-28 Impact factor: 2.728
Authors: Bram Rochwerg; Sharon Einav; Dipayan Chaudhuri; Jordi Mancebo; Tommaso Mauri; Yigal Helviz; Ewan C Goligher; Samir Jaber; Jean-Damien Ricard; Nuttapol Rittayamai; Oriol Roca; Massimo Antonelli; Salvatore Maurizio Maggiore; Alexandre Demoule; Carol L Hodgson; Alain Mercat; M Elizabeth Wilcox; David Granton; Dominic Wang; Elie Azoulay; Lamia Ouanes-Besbes; Gilda Cinnella; Michela Rauseo; Carlos Carvalho; Armand Dessap-Mekontso; John Fraser; Jean-Pierre Frat; Charles Gomersall; Giacomo Grasselli; Gonzalo Hernandez; Sameer Jog; Antonio Pesenti; Elisabeth D Riviello; Arthur S Slutsky; Renee D Stapleton; Daniel Talmor; Arnaud W Thille; Laurent Brochard; Karen E A Burns Journal: Intensive Care Med Date: 2020-11-17 Impact factor: 17.440