Authors' objectives: This health technology assessment evaluates the effectiveness and safety of home-based heated humidified high-flow therapy (HHHFT) for people with respiratory conditions who lack alternative treatment options to provide equivalent respiratory support at home, and for children with obstructive sleep apnea who cannot tolerate conventional respiratory therapies at home. It also evaluates the budget impact of publicly funding home-based HHHFT and the experiences, preferences, and values of people with respiratory conditions.

Authors' results and conclusions: RESULTS We did not identify any studies that met the eligibility criteria for our clinical evidence review. The estimated annual budget impact of publicly funding home-based HHHFT in Ontario over the next 5 years ranges from cost savings of $185,981 for children with pediatric OSA to an additional $2.5 million for adults and children with other respiratory conditions. We estimate that publicly funding home-based HHHFT would result in 99 fewer inpatient visits and 127 fewer outpatient visits related to pediatric OSA. It would also result in 653 inpatient days avoided for adults and children with other respiratory conditions. Due to data limitations, these budget impact estimates are highly uncertain. Care partners discussed the difficulties of caring for a child with complex care needs – particularly those of caring for a child with a tracheostomy. They shared their experiences with alternative treatment options that were ineffective in managing their child's symptoms. People with direct experience using home-based HHHFT highlighted its positive impact on their child's respiratory symptoms, improving quality of life and reducing hospital and specialist visits. Initial and ongoing costs were the biggest barriers to accessing HHHFT. CONCLUSIONS We did not identify any studies that specifically evaluated the comparative effectiveness and safety of home-based HHHFT in relation to our research questions, but we did identify several studies conducted in other contexts that demonstrated the benefits of HHHFT, including improved oxygenation, reduced respiratory rates, decreased OSA severity, and fewer acute exacerbations of chronic obstructive pulmonary disease when used in hospital and at home. As well, HHHFT is used widely in Ontario hospitals, is generally considered to be clinically effective, and is standard care in such settings. We estimate that publicly funding home-based HHHFT in Ontario over the next 5 years would result in cost savings for children with pediatric OSA and additional costs of $2.5 million for adults and children with other chronic respiratory conditions. We estimate that publicly funding home-based HHHFT would result in fewer inpatient visits, fewer outpatient visits, and inpatient days avoided. Care partners of children with respiratory conditions viewed home-based HHHFT positively; for many, it became an essential treatment when other options failed. However, cost was a substantial barrier to accessing this treatment.

Authors' recommendations: Ontario Health, based on guidance from the Ontario Health Technology Advisory Committee, recommends publicly funding home-based heated humidified high-flow therapy for people with respiratory conditions who lack equivalent treatment options at home. 

Authors' methods: We performed a systematic literature search of the clinical evidence of the effectiveness and safety of home-based HHHFT for the populations described above. We performed a systematic economic literature search, but we did not conduct a primary economic evaluation because of a lack of evidence. We analyzed the budget impact of publicly funding home-based HHHFT in children with pediatric OSA and in adults and children with other respiratory conditions in Ontario. To contextualize the potential value of home-based HHHFT, we aimed to speak with adults and care partners of children in Ontario who had lived experience of respiratory conditions, including those with and without direct experience of HHHFT.

Project Status: Completed

URL for project: https://ontariohealth.ca/system/health-innovation-pathway/reviews

URL for protocol: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024594417

Year Published: 2025

URL for published report: https://pmc.ncbi.nlm.nih.gov/articles/PMC12647933/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Pubmed ID: 41312335

Organisation Name: Ontario Health

Contact Address: 525 University Ave, Toronto, ON M5G 2L3

Contact Name: HealthInnovationPathway@ontariohealth.ca

Contact Email: HealthInnovationPathway@ontariohealth.ca

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