Cost-effectiveness of Nasal High Flow versus CPAP for newborn infants in special-care nurseries

Huang, Li, Manley, Brett J., Arnolda, Gaston R.B., Owen, Louise S., Wright, Ian M.R., Foster, Jann P., Davis, Peter G., Buckmaster, Adam G., and Dalziel, Kim M. (2021) Cost-effectiveness of Nasal High Flow versus CPAP for newborn infants in special-care nurseries. Pediatrics, 148 (2). e2020020438.

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BACKGROUND: Treating respiratory distress in newborns is expensive. We compared the cost-effectiveness of 2 common noninvasive therapies, nasal continuous positive airway pressure (CPAP) and nasal high-flow (nHF), for newborn infants cared for in nontertiary special care nurseries.

METHODS: The economic evaluation was planned alongside a randomized control trial conducted in 9 Australian special care nurseries. Costs were considered from a hospital perspective until infants were 12 months of age. A total of 754 infants with respiratory distress, born $31 weeks’ gestation and with birth weight $1200 g, <24 hours old, requiring noninvasive respiratory support and/or supplemental oxygen for >1 hour were recruited during 2015–2017. Inpatient costing records were obtained for 753 infants, of whom 676 were included in the per-protocol analysis. Two scenarios were considered: (1) CPAP versus nHF, with infants in the nHF group having “rescue” CPAP backup available (trial scenario); and (2) CPAP versus nHF, as sole primary support (hypothetical scenario). Effectiveness outcomes were rate of endotracheal intubation and transfer to a tertiary-level NICU.

RESULTS: As sole primary support, CPAP is more effective and on average cheaper, and thus is superior. However, nHF with back-up CPAP produced equivalent cost and effectiveness results, and there is no reason to make a decision between the 2 treatments on the basis of the cost or effectiveness outcomes.

CONCLUSIONS: Nontertiary special care nurseries choosing to use only 1 of the modes should choose CPAP. In units with both modes available, using nHF as first-line therapy may be acceptable if there is back-up CPAP.

Item ID: 70205
Item Type: Article (Research - C1)
ISSN: 1098-4275
Copyright Information: © 2021 by the American Academy of Pediatrics
Date Deposited: 11 May 2022 23:39
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3213 Paediatrics > 321399 Paediatrics not elsewhere classified @ 100%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 100%
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