Cost-Effectiveness of Nasal High Flow Versus CPAP for Newborn Infants in Special-Care Nurseries.

Autor:	Huang L; Centre for Health Policy., Manley BJ; Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia.; Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Victoria, Australia.; Clinical Sciences, Murdoch Children's Research Institute, Victoria, Australia., Arnolda GRB; School of Population Health, University of New South Wales, New South Wales, Australia.; Australian Institute for Healthcare Innovation, Macquarie University, New South Wales, Australia., Owen LS; Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia.; Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Victoria, Australia.; Clinical Sciences, Murdoch Children's Research Institute, Victoria, Australia., Wright IMR; Illawarra Health and Medical Research Institute, University of Wollongong and Illawarra and Shoalhaven Health District, New South Wales, Australia.; College of Medicine and Dentistry, James Cook University, Queensland, Australia., Foster JP; School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia.; Ingham Institute, New South Wales, Australia.; Sydney Medical School, Sydney Nursing School, University of Sydney, New South Wales, Australia., Davis PG; Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia.; Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Victoria, Australia.; Clinical Sciences, Murdoch Children's Research Institute, Victoria, Australia., Buckmaster AG; Paediatrics, Central Coast Local Health District, New South Wales, Australia.; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia., Dalziel KM; Centre for Health Policy kim.dalziel@unimelb.edu.au.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2021 Aug; Vol. 148 (2). Date of Electronic Publication: 2021 Jul 16.
DOI:	10.1542/peds.2020-020438
Abstrakt:	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. Competing Interests: POTENTIAL CONFLICTS OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2021 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu