Konduri G Ganesh, Menzin Joseph, Frean Molly, Lee Terry, Potenziano Jim, Singer Joel
a a Division of Neonatology, Department of Pediatrics and Children's Research Institute , Medical College of Wisconsin , Milwaukee , WI , USA.
b b Boston Health Economics Inc. , Waltham , MA , USA.
J Med Econ. 2015;18(8):612-8. doi: 10.3111/13696998.2015.1038270. Epub 2015 May 7.
We reported recently that early use of inhaled nitric oxide therapy (iNO) for term and late preterm infants with hypoxic respiratory failure (HRF) at an oxygenation index (OI) of ≥15 and <20 is associated with earlier discharge from the hospital, relative to babies treated at OI ≥25. The objective of the present analysis is to determine whether earlier use of iNO in this cohort leads to lower cost of medical care.
We used a decision-analytic model, which was developed to compare hospital resource use and costs associated with early versus standard use of iNO in HRF. The model population included infants with moderate HRF caused by primary pulmonary hypertension with an OI ≥15 and <20. A hypothetical case population of 1000 patients was assumed and probabilistic sensitivity analyses were completed where all the clinical inputs into the model were varied. Two deterministic sensitivity analyses were also completed, one surrounding the hospital cost inputs and another surrounding the cost of iNO.
Early iNO was associated with fewer hospital days, fewer days of ventilation and fewer hours on extracorporeal membrane oxygenation (ECMO). In probabilistic sensitivity analyses, total costs per patient were $88,518 ± $7574 and $92,581 ± $9664 for early iNO and standard iNO, respectively. The probability of early iNO being cost-effective was approximately 72%, based on a willingness to pay $100,000 or less to prevent ECMO therapy and/or death. In both deterministic sensitivity analyses, early iNO was cost-saving.
Our analysis shows that early use of iNO at an OI of ≥15 and <20 may be associated with shorter hospitalizations and a decreased cost of care for term/late preterm infants with HRF associated with pulmonary hypertension. Our results are based on clinical data from a single trial; future research using data from real-world practice is warranted.
我们最近报道,对于氧合指数(OI)≥15且<20的足月儿和晚期早产儿缺氧性呼吸衰竭(HRF),与OI≥25时接受治疗的婴儿相比,早期使用吸入一氧化氮疗法(iNO)可使患儿更早出院。本分析的目的是确定在此队列中更早使用iNO是否会降低医疗费用。
我们使用了一个决策分析模型,该模型用于比较HRF中早期与标准使用iNO相关的医院资源利用和成本。模型人群包括由原发性肺动脉高压导致中度HRF且OI≥15且<20的婴儿。假设一个1000例患者的假设病例人群,并进行概率敏感性分析,其中模型中的所有临床输入都有所变化。还完成了两项确定性敏感性分析,一项围绕医院成本输入,另一项围绕iNO成本。
早期使用iNO与住院天数减少、通气天数减少以及体外膜肺氧合(ECMO)使用时间缩短相关。在概率敏感性分析中,早期iNO和标准iNO治疗的每位患者总费用分别为88,518美元±7574美元和92,581美元±9664美元。基于为预防ECMO治疗和/或死亡支付10万美元或更少的意愿,早期iNO具有成本效益的概率约为72%。在两项确定性敏感性分析中,早期iNO均节省成本。
我们的分析表明,对于与肺动脉高压相关的HRF足月儿/晚期早产儿,在OI≥15且<20时早期使用iNO可能与住院时间缩短和护理成本降低有关。我们的结果基于一项单一试验的临床数据;有必要使用来自实际临床实践的数据进行未来研究。