Respiratory medicine · 2025
Economic analysis of high-flow nasal oxygen compared with noninvasive ventilation in patients with acute respiratory failure: results from the RENOVATE randomized clinical trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Beck da Silva Etges Ana Paula, Marcolino Miriam Allein Zago, Bianchini Larissa, Kawano-Dourado Letícia, Negrelli Karina, Gurgel Rodrigo, Pinheiro do Carmo Mendrico Samara, Martins Lucas, Nakagawa Renato Hideo, Maia Israel S, Cavalcanti Alexandre Biasi, Polanczyk Carisi Anne
Аннотация
CONTEXT: High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) are commonly used for patients with acute respiratory failure (ARF). The RENOVATE trial previously established its clinical noninferiority.
OBJECTIVE: To assess the incremental cost of HFNO compared to NIV across four ARF groups: nonimmunocompromised with hypoxemia, chronic obstructive pulmonary disease exacerbation, acute cardiogenic pulmonary edema, and hypoxemic COVID-19.
METHODS: A cost-minimization analysis was conducted using primary outcome data, probabilities, and cost inputs from the RENOVATE trial. Direct costs were estimated using a combination of macro- and micro-costing approaches. The clinical outcome was progression to mechanical ventilation or death within 7 days. A 90-day decision-tree model compared intervention costs across disease categories. Sensitivity analyses evaluated the influence of individual parameters on outcomes.
RESULTS: Among 1800 patients enrolled across 33 Brazilian sites, 1716 were included in the primary analysis (883 in each arm). HFNO was associated with estimated cost savings in three groups: nonimmunocompromised hypoxemic patients (-$5105; 95 % CI -51,257 to 41,378), COPD (-$1267; 95 % CI -49,088 to 76,636), and cardiogenic pulmonary edema (-$2493; 95 % CI 28,682 to 21,596). However, for hypoxemic COVID-19 patients, HFNO incurred higher costs (+$4388; 95 % CI -56,174 to 69,640). Sensitivity analyses identified intubation rate, mortality, and ICU stay as key cost drivers.
CONCLUSION: HFNO demonstrated economic neutrality in non-COVID-19 ARF groups compared to NIV. No economic advantage was seen for COVID-19 patients. Cost-effectiveness should be considered alongside patient-specific clinical factors for optimal treatment decisions.
OBJECTIVE: To assess the incremental cost of HFNO compared to NIV across four ARF groups: nonimmunocompromised with hypoxemia, chronic obstructive pulmonary disease exacerbation, acute cardiogenic pulmonary edema, and hypoxemic COVID-19.
METHODS: A cost-minimization analysis was conducted using primary outcome data, probabilities, and cost inputs from the RENOVATE trial. Direct costs were estimated using a combination of macro- and micro-costing approaches. The clinical outcome was progression to mechanical ventilation or death within 7 days. A 90-day decision-tree model compared intervention costs across disease categories. Sensitivity analyses evaluated the influence of individual parameters on outcomes.
RESULTS: Among 1800 patients enrolled across 33 Brazilian sites, 1716 were included in the primary analysis (883 in each arm). HFNO was associated with estimated cost savings in three groups: nonimmunocompromised hypoxemic patients (-$5105; 95 % CI -51,257 to 41,378), COPD (-$1267; 95 % CI -49,088 to 76,636), and cardiogenic pulmonary edema (-$2493; 95 % CI 28,682 to 21,596). However, for hypoxemic COVID-19 patients, HFNO incurred higher costs (+$4388; 95 % CI -56,174 to 69,640). Sensitivity analyses identified intubation rate, mortality, and ICU stay as key cost drivers.
CONCLUSION: HFNO demonstrated economic neutrality in non-COVID-19 ARF groups compared to NIV. No economic advantage was seen for COVID-19 patients. Cost-effectiveness should be considered alongside patient-specific clinical factors for optimal treatment decisions.