First-line oxygen therapy with high-flow in bronchiolitis is not cost saving for the health service
AuthorGc, VS; Franklin, D; Whitty, JA; Dalziel, SR; Babl, FE; Schlapbach, LJ; Fraser, JF; Craig, S; Neutze, J; Oakley, E; ...
Source TitleArchives of Disease in Childhood
PublisherBMJ PUBLISHING GROUP
Document TypeJournal Article
CitationsGc, V. S., Franklin, D., Whitty, J. A., Dalziel, S. R., Babl, F. E., Schlapbach, L. J., Fraser, J. F., Craig, S., Neutze, J., Oakley, E. & Schibler, A. (2020). First-line oxygen therapy with high-flow in bronchiolitis is not cost saving for the health service. ARCHIVES OF DISEASE IN CHILDHOOD, 105 (10), pp.975-980. https://doi.org/10.1136/archdischild-2019-318427.
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Open Access URLAccepted version
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.
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