Exploring Heterogeneity in Cost-Effectiveness Using Machine Learning Methods: A Case Study Using the FIRST-ABC Trial.

Autor:	Hattab Z; Discipline of Economics, University of Galway, Galway, Ireland.; Department of Mathematics, An-Najah National University, Nablus, Palestine, London, UK., Doherty E; Discipline of Economics, University of Galway, Galway, Ireland., Sadique Z; Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK., Ramnarayan P; Section of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.; Paediatric Intensive Care Unit, St Mary's Hospital, London, UK., O'Neill S; Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK.
Jazyk:	angličtina
Zdroj:	Medical care [Med Care] 2024 Jul 01; Vol. 62 (7), pp. 449-457. Date of Electronic Publication: 2024 Jun 07.
DOI:	10.1097/MLR.0000000000002010
Abstrakt:	Objective: The aim of this study was to explore heterogeneity in the cost-effectiveness of high-flow nasal cannula (HFNC) therapy compared with continuous positive airway pressure (CPAP) in children following extubation. Design: Using data from the FIRST-line support for Assistance in Breathing in Children (FIRST-ABC) trial, we explore heterogeneity at the individual and subgroup levels using a causal forest approach, alongside a seemingly unrelated regression (SUR) approach for comparison. Settings: FIRST-ABC is a noninferiority randomized controlled trial (ISRCTN60048867) including children in UK paediatric intensive care units, which compared HFNC with CPAP as the first-line mode of noninvasive respiratory support. Patients: In the step-down FIRST-ABC, 600 children clinically assessed to require noninvasive respiratory support were randomly assigned to HFNC and CPAP groups with 1:1 treatment allocation ratio. In this analysis, 118 patients were excluded because they did not consent to accessing their medical records, did not consent to follow-up questionnaire or did not receive respiratory support. Measurements and Main Results: The primary outcome of this study is the incremental net monetary benefit (INB) of HFNC compared with CPAP using a willingness-to-pay threshold of £20,000 per QALY gain. INB is calculated based on total costs and quality adjusted life years (QALYs) at 6 months. The findings suggest modest heterogeneity in cost-effectiveness of HFNC compared with CPAP at the subgroup level, while greater heterogeneity is detected at the individual level. Conclusions: The estimated overall INB of HFNC is smaller than the INB for patients with better baseline status suggesting that HFNC can be more cost-effective among less severely ill patients. Competing Interests: The authors declare no conflict of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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