Cost-effectiveness analysis of the use of high-flow oxygen through nasal cannula in intensive care units in NHS England

ABSTRACT

Objective: To estimate the cost-effectiveness of Nasal High Flow (NHF) in the intensive care unit (ICU) compared with standard oxygen or non-invasive ventilation (NIV) from a UK NHS perspective.

Methods: Three cost-effectiveness models were developed to reflect scenarios of NHF use: first-line therapy (pre-intubation model); post-extubation in low-risk, and high-risk patients. All models used randomized control trial data on the incidence of intubation/re-intubation, events leading to intubation/re-intubation, mortality and complications. NHS reference costs were primarily used. Sensitivity analyses were conducted.

Results: When used as first-line therapy, Optiflow™ NHF gives an estimated cost-saving of £469 per patient compared with standard oxygen and £611 versus NIV. NHF cost-savings for high severity sub-group were £727 versus standard oxygen, and £1,011 versus NIV.

For low-risk post-intubation patients, NHF generates estimated cost-saving of £156 versus standard oxygen. NHF decreases the number of re-intubations required in these scenarios. Results were robust in most sensitivity analyses.

For high-risk post-intubation patients, NHF cost-savings were £104 versus NIV. NHF results in a non-significant increase in re-intubations required. However, reduction in respiratory failure offsets this.

Conclusions: For patients in ICU who are at risk of intubation or re-intubation, NHF cannula is likely to be cost-saving.

KEYWORDS:

• Cost analysis
• humidifier
• intratracheal intubation
• noninvasive ventilation
• oxygen inhalation therapy

Acknowledgments

Fisher & Paykel Healthcare, the manufacturer of the AIRVO device, provided comments on the draft manuscript. Their comments were incorporated into the final version of the manuscript.

Declaration of interest

E Eaton Turner and M Jenks’ employer, York Health Economics Consortium Ltd, received funding for health economics consultancy from Fisher & Paykel Healthcare, manufacturers of the AIRVO device. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Additional information

Funding

Financial support for this manuscript was provided by Fisher and Paykel Healthcare Limited.