Comparison of two oxygen saturation targets to decide on hospital discharge of infants with viral bronchiolitis living at high altitudes: a cost-effectiveness analysis

Abstract

Objectives

The objective of the current study was to evaluate the cost-effectiveness of two pulse oximetry (SpO2) thresholds to decide on hospital discharge when all other discharge criteria are met, in infants with viral bronchiolitis living at high altitudes.

Methods

A decision analysis model was developed to estimate the cost‐effectiveness of the use of an SpO2 threshold of 90% versus one of 85% for deciding whether infants hospitalized for viral bronchiolitis can be safely discharged to home, from a third-party payer’s perspective. The main outcome was discharge to home at day 4 of the initial hospitalization. The time horizon was 28 days after discharge from hospital. We performed deterministic sensitivity analyses and probabilistic sensitivity analyses.

Results

Compared to the use of an SpO2 threshold of 90%, treating infants with viral bronchiolitis with the use of an SpO2 threshold of 85% resulted in lower total costs (US$119.39 vs. US$188.357 mean cost per patient) and a greater probability of discharge to home at day 4 of the initial hospitalization (0.8400 vs. 0.7600), therefore being a dominant strategy. Sensitivity analyses were in line with base case results.

Conclusions

In Bogota, a high-altitude city, in infants admitted for viral bronchiolitis, the use of an SpO2 threshold of 85% to decide on hospital discharge when all other discharge criteria are met is dominant because it entails a greater probability of discharge to home at day 4 of the initial hospitalization and generates fewer costs than the use of an SpO2 threshold of 90%.

Keywords:

• Bronchiolitis
• cost‐effectiveness
• health economics
• high-altitude
• oxygen saturation

Transparency

Declaration of funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of financial/other relationships

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Carlos E. Rodriguez M 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. Monica P. Sossa-Briceño 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. Jefferson Buendia 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.

Acknowledgements

Authors thank Mr. Charlie Barret for his editorial assistance. Mr. Charlie Barret has provided permission to be acknowledged.