Original Title: Eficiencia de la oxigenoterapia de alto flujo para el tratamiento de dificultades respiratorias en pediatría

Authors' objectives: To assess published economic evidence on the cost-effectiveness of HFNC oxygen therapy as an alternative to SOT and non-invasive oxygen therapy using CPAP in the treatment of respiratory compromise in paediatric patients.

Authors' results and conclusions: The search carried out retrieved a total of 172 potentially relevant studies, of which 133 were retained for title and abstract screening. Of these, six studies were identified for full text reading, four then being selected for analysis and quality assessment. Of these four studies, two reported cost minimisation analysis and the other two cost-effectiveness analysis based on decision-tree models. The studies compared heated humidified HFNC oxygen therapy with SOT, or CPAP oxygen therapy in preterm infants or infants with bronchiolitis. The quality of the evidence was classified as high in one study, highto-moderate in two and low in the fourth. The main problems observed were a lack of transferability of the results to the population and context analysed, methodological deficiencies and potential conflicts of interest. One of the studies concluded that in infants with bronchiolitis requiring additional oxygen, HFNC therapy was cost-effective compared to SOT in the two scenarios analysed, with lower associated costs (first scenario: – € 55 [equivalent to – € 41.96 in Spain in 2020], and second scenario: – € 272 [equivalent to – € 207.53 in Spain in 2020]) and greater effectiveness, with a 0.84 % point lower rate of paediatric intensive care unit admission in both scenarios. Two studies indicated that the HFNC therapy was not cost-effective compared to SOT with escalation to HFNC therapy in the event of treatment failure or compared to CPAP therapy, no statistically significant differences being found in the measures of effectiveness, total hospital stay (0.18, 95 % CI: – 0.09 - 0.44) and need for reintubation within 7 days (0.76, 95 CI %: 0.54 - 1.09), or in costs (AU$ 420; 95 CI %: -AU$ 176 to AU$ 1,002 [equivalent to € 193.95; 95 % CI: –€ 81.27 to € 462.71 in Spain in 2020] for HFNC therapy versus SOT with escalation to HFNC and – £ 26.30 [equivalent to € 26.28 in Spain in 2020] for HFNC versus CPAP therapy). Finally, another study indicated that CPAP therapy could be cost-effective compared to HFNC therapy. Comparing CPAP therapy to HFNC therapy without and with rescue CPAP, respectively, the estimated incremental cost-effectiveness ratios were AU$ 7,027 (equivalent to € 3,277.18 in Spain in 2020) per ventilation avoided with the use of CPAP (incremental effectiveness = – 0.12, p = 0.06; and incremental cost: AU$ 833 [equivalent to € 627.60 in Spain in 2020], p = 0.82), and AU$ 178,857 (equivalent to € 83,413.58 in Spain in 2020) per ventilation avoided with the use of CPAP (incremental effectiveness = 0.02, p = 0.57; and incremental cost = AU$ 3,142 [equivalent to € 1,465.33 in Spain in 2020], p = 0.39). Conclusion The evidence analysed seems to indicate that the routine use of HFNC therapy as first-line oxygen therapy compared to SOT or CPAP therapy is not cost-effective for the treatment of infants with bronchiolitis or preterm infants requiring respiratory support.

Authors' methods: We conducted a systematic review of economic evaluations to assess the cost-effectiveness of HFNC oxygen therapy with the aim of providing objective data to facilitate decision making and decide whether use of this technique should be promoted in clinical practice. The methodology was based on a structured search for economic evaluation studies in certain scientific databases (Medline, Embase, NHS Economic Evaluation Database [NHS EED] and the Cost-Effectiveness Analysis [CEA] Registry), critical appraisal of studies included, synthesis of results and assessment of the methodological quality in relation to the context of the Spanish National Health Service. The critical appraisal and the synthesis of results were performed by two reviewers, disagreements being resolved by consensus, while the methodological quality of the studies was assessed using the FLC 3.0 critical appraisal tools.

Project Status: Completed

Year Published: 2021

URL for published report: https://www.euskadi.eus/contenidos/informacion/osteba_publicacion/eu_def/adjuntos/Eficiencia_de_la_oxigenoterapia_de_alto_flujo.pdf

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>