High-flow oxygen therapy is more effective and less expensive for bronchiolitis than standard low-flow oxygen therapy: A decision analysis

Abstract

High-flow (HF) oxygen therapy is a new promising way to treat infant bronchiolitis. Experimental studies have reported beneficial physiologic effects, and the clinical experience has been positive. The aim of this study was to compare the cost-effectiveness of HF oxygen therapy and standard low-flow (LF) oxygen therapy in infant bronchiolitis. The decision tree in the decision analysis was used to evaluate the cost-effectiveness. The actual cost data were obtained from our recently published case-control study. The data on the effectiveness of HF oxygen therapy were collected from earlier published studies, using the admission rate to pediatric intensive care unit (PICU) as the effectiveness measure. The expected hospitalization costs of each treatment episode of infant bronchiolitis varied between €1,312 to €2,644 in the HF group and €1,598 to €3,764 in the LF group. The incremental cost-effective ratios varied between €-65 to €-324 per 1% reduction in the PICU admission rate. The PICU admission rates and consequential costs were lower for HF than for LF oxygen therapy. HF oxygen therapy proved more cost-effective than standard treatment in all baseline analyses, and was also more cost-effective in the sensitivity analyses, except for in the worst-case scenario analysis. In conclusion, our modelling demonstrated that treating all infants, who need oxygen support during hospitalization for bronchiolitis, with HF instead of LF oxygen therapy is cost-effective. However, prospective randomized controlled trials are needed to provide evidence of the indications, benefits and cost-effectiveness of using HF oxygen therapy for infants with bronchiolitis.