Chen Ariel, Deshmukh Ashish A, Richards-Kortum Rebecca, Molyneux Elizabeth, Kawaza Kondwani, Cantor Scott B
BMC Pediatr. 2014 Nov 25;14:288. doi: 10.1186/s12887-014-0288-1.
A low-cost bubble continuous positive airway pressure (bCPAP) device has been shown to be an excellent clinical alternative to nasal oxygen for the care of neonates with respiratory difficulty. However, the delivery of bCPAP requires more resources than the current routine care using nasal oxygen. We performed an economic evaluation to determine the cost-effectiveness of a low-cost bCPAP device in providing ventilatory support for neonates in Malawi.
We used patient-level clinical data from a previously published non-randomized controlled study. Economic data were based on the purchase price of supplies and equipment, adjusted for shelf life, as well as hospital cost data from the World Health Organization. Costs and benefits were discounted at 3%. The outcomes were measured in terms of cost, discounted life expectancy, cost/life year gained and net benefits of using bCPAP or nasal oxygen. The incremental cost-effectiveness ratio and incremental net benefits determined the value of one intervention compared to the other. Subgroup analysis on several parameters (birth weight categories, diagnosis of respiratory distress syndrome, and comorbidity of sepsis) was conducted to evaluate the effect of these parameters on the cost-effectiveness.
Nasal oxygen therapy was less costly (US$29.29) than the low-cost bCPAP device ($57.78). Incremental effectiveness associated with bCPAP was 6.78 life years (LYs). In the base case analysis, the incremental cost-effectiveness ratio for bCPAP relative to nasal oxygen therapy was determined to be $4.20 (95% confidence interval, US$2.29-US$16.67) per LY gained. The results were highly sensitive for all tested subgroups, particularly for neonates with birth weight 1- < 1.5 kg, respiratory distress syndrome, or comorbidity of sepsis; these subgroups had a higher probability that bCPAP would be cost effective.
The bCPAP is a highly cost-effective strategy in providing ventilatory support for neonates in Malawi.
一种低成本的气泡持续气道正压通气（bCPAP）设备已被证明是用于护理呼吸困难新生儿的鼻导管吸氧的一种出色的临床替代方法。然而，与目前使用鼻导管吸氧的常规护理相比，bCPAP的实施需要更多资源。我们进行了一项经济学评估，以确定一种低成本bCPAP设备在为马拉维新生儿提供通气支持方面的成本效益。
我们使用了先前发表的一项非随机对照研究中的患者层面的临床数据。经济数据基于用品和设备的采购价格，并根据保质期进行了调整，以及来自世界卫生组织的医院成本数据。成本和效益按3%进行贴现。结果通过成本、贴现预期寿命、成本/获得的生命年以及使用bCPAP或鼻导管吸氧的净效益来衡量。增量成本效益比和增量净效益确定了一种干预措施相对于另一种干预措施的价值。对几个参数（出生体重类别、呼吸窘迫综合征的诊断以及败血症合并症）进行了亚组分析，以评估这些参数对成本效益的影响。
鼻导管吸氧疗法的成本（29.29美元）低于低成本bCPAP设备（57.78美元）。与bCPAP相关的增量效益为6.78个生命年（LYs）。在基础病例分析中，相对于鼻导管吸氧疗法，bCPAP的增量成本效益比被确定为每获得一个LYs为4.20美元（95%置信区间，2.29美元 - 16.67美元）。对于所有测试的亚组，结果都高度敏感，特别是对于出生体重为1 - ＜1.5 kg、患有呼吸窘迫综合征或败血症合并症的新生儿；这些亚组中bCPAP具有成本效益的可能性更高。
在为马拉维新生儿提供通气支持方面，bCPAP是一种具有高度成本效益的策略。
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