Inhaled nitric oxide in term/late preterm neonates with hypoxic respiratory failure: estimating the financial impact of earlier use

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.

Keywords::

• ECMO
• Inhaled nitric oxide
• Lung disease

Transparency

Declaration of funding

This study was sponsored by Ikaria Inc.

Declaration of financial/other relationships

M.F. and J.M. have disclosed that they are employees of Boston Health Economics Inc., who were paid consultants to Ikaria Inc. in connection with the study and development of this research article. J.P. has disclosed that he is an employee of and owns stock in the sponsor, Ikaria Inc. G.G.K. has disclosed that he was also a paid consultant to Ikaria Inc. in connection with the study and development of this research article. He received an unrestricted grant (awarded to Medical College of Wisconsin) from Ikaria Inc. for supplemental data analysis of the trial supporting this research article; he also received consulting fees from Actelion Pharmaceuticals Ltd, Switzerland, for serving on the Data Safety Monitoring Board of a randomized clinical trial of bosentan in treating persistent pulmonary hypertension of the newborn (a condition related to that reported in this article). T.L. and J.S. have no financial/other relationships to disclose.

JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors gratefully acknowledge Dr. John Zupancic of Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA for his assistance in model design.