Oxygen saturation thresholds for bronchiolitis at high altitudes: a cost-effectiveness analysis

ABSTRACT

Background

There is evidence suggesting that exaggerated reliance on pulse oximetry (SpO2) and the use of arbitrary/inadequate thresholds of SpO2 might drive unnecessary hospitalizations for viral bronchiolitis, especially among high-altitude residents. The aim of the present study was to compare the cost-effectiveness of two oxygen SpO2 thresholds for deciding whether infants with viral bronchiolitis living at high altitudes need hospital admission or can be discharged home.

Methods

A cost-effectiveness study was performed to compare the cost and clinical outcomes of two oxygen SpO2 thresholds, adjusted or not, to an altitude above the sea level of Bogota, Colombia (2640 m), for deciding whether infants with viral bronchiolitis need hospitalization or can be discharged home. The principal outcome was avoidance of hospital admission.

Results

Compared to the use of an SpO2 threshold of 90%, using an SpO2 threshold of 85% in infants with viral bronchiolitis was associated with lower overall costs (US$130.4 vs. US$194.0 average cost per patient) and a higher probability of hospitalization avoided (0.7500 vs. 0.5900), thus leading to dominance.

Conclusions

The use of an SpO2 threshold below 90% for deciding on hospitalization in infants with viral bronchiolitis living at high altitudes appears to be logical, secure, and cost-effective.

KEYWORDS:

• Cost‐effectiveness
• health economics
• high-altitude
• oxygen saturation
• oxygen therapy
• viral bronchiolitis

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Author contributions

C Rodriguez-Martinez authorship contribution consisted of the following: 1) Substantial contributions to the study, including conceptualization/design, methodology, data curation, investigation, formal analysis, 2) Participation in the writing and/or revision, including writing, drafting the initial manuscript, 3) Final approval of the version to be published; M Sossa-Briceno authorship contribution consisted of the following: 1) Substantial contributions to the study, including conceptualization/design, methodology, supervision/oversight, 2) Participation in the writing and/or revision, including writing, drafting the initial manuscript, 3) Final approval of the version to be published; G Nino authorship contribution consisted of the following: 1) Substantial contributions to the study, including conceptualization/design, methodology, data curation, investigation, formal analysis, supervision/oversight, resources, 2) Participation in the writing and/or revision, including writing, review, or editing of the manuscript, 3) Final approval of the version to be published. All authors agree for the final version of the manuscript to be published.

Additional information

Funding

The study has been financed with the authors’ own resources.