Abstract
Background: High flow therapy (HFT) has been demonstrated to be a safe and effective noninvasive respiratory support technique for the treatment of pre-term infants in neonatal intensive care. Objectives: Our objective was to develop a quantitative framework based on available evidence to estimate the economic impact of adoption of a HFT respiratory support strategy compared to current standard of care. Methods: Model parameters were derived from a recent study comparing respiratory modality utilization between five US-based neonatal intensive care units (NICUs) adopting a HFT strategy and a larger pool of NICUs in the Vermont-Oxford Network (VON), and from single center experience. We computed the total cost difference between the respiratory support strategies based on published cost data. Parameter uncertainty was tested in sensitivity analyses. Results: The constructed model projected expected cost savings of $2,317 for the HFT strategy for the base case. Results were sensitive to length of HFT use, length of CMV, cost of HFT, and length of nCPAP support. Conclusions: Adoption of a HFT strategy appears to be associated with meaningful savings in total NICU episode of care costs, primarily because of reductions in the time of conventional mechanical ventilation. Further research is warranted to substantiate these findings.
Highlights
In the last decades, advances in neonatal intensive care have greatly contributed to improvements in survival and outcomes of preterm infants
Adoption of a High flow therapy (HFT) strategy appears to be associated with meaningful savings in total neonatal intensive care units (NICUs) episode of care costs, primarily because of reductions in the time of conventional mechanical ventilation
While a number of studies have investigated the safety and clinical effectiveness of HFT compared to nasal continuous positive airway pressure (nCPAP), and found HFT to be associated with comparable outcomes to nCPAP,[3,4,5] only limited work has been done to understand the economic impact of adopting a HFT-based respiratory support strategy, compared to other strategies
Summary
Advances in neonatal intensive care have greatly contributed to improvements in survival and outcomes of preterm infants. Use of less invasive respiratory support technologies might provide an opportunity to contribute to reductions in the total costs of care in a neonatal intensive care unit (NICU), which continue to be staggering and remain a concern to caregivers, hospital administrators and payers. We propose a quantitative framework for the economic evaluation of the adoption of a HFT strategy This model is based on recent data comparing utilization data associated with adoption of a HFT compared to non-HFT strategy, and uses information and cost from the published literature to complement these data. High flow therapy (HFT) has been demonstrated to be a safe and effective noninvasive respiratory support technique for the treatment of pre-term infants in neonatal intensive care
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