Faculty Collaboration Database

Inhaled nitric oxide in term/late preterm neonates with hypoxic respiratory failure: estimating the financial impact of earlier use. J Med Econ 2015;18(8):612-8

Date

04/09/2015

Pubmed ID

25853867

DOI

10.3111/13696998.2015.1038270

Scopus ID

2-s2.0-84964343936 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Author List

Konduri GG, Menzin J, Frean M, Lee T, Potenziano J, Singer J

Author

Girija Ganesh Konduri MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Administration, Inhalation
Extracorporeal Membrane Oxygenation
Female
Hospital Charges
Humans
Hypertension, Pulmonary
Infant, Newborn
Length of Stay
Male
Models, Econometric
Nitric Oxide
Reproducibility of Results
Respiration, Artificial
Respiratory Insufficiency
Vasodilator Agents