Respirology | APSR Respiratory Medicine Journal

In Non-COVID-19 Acute Respiratory Failure, HFNO May Cost Less Than NIV

High-flow nasal oxygen (HFNO) may be cost-neutral or cost-saving compared with noninvasive ventilation (NIV) among patients with acute respiratory failure (ARF), but not for patients critically ill with COVID-19, according to study findings published in Respiratory Medicine.

The economic analysis study used outcomes and cost data from the RENOVATE clinical trial (ClinicalTrials.Gov Identifier: NCT03643939), conducted at 33 sites in Brazil, to compare the cost of using HFNO vs NIV in ARF. 

The analysis evaluated the incremental cost associated with HFNO vs NIV for treating 4 subgroups of ARF patients: (1) those who were nonimmunocompromised with hypoxemia; (2) those with COPD exacerbations with respiratory acidosis; (3) those with acute cardiogenic pulmonary edema; and (4) those with hypoxemic COVID-19. Notably, clinical outcomes from HFNO were previously found to be noninferior to NIV among these subgroups in the RENOVATE trial, which used a decision-tree model to compare HFNO and NIV within 90 days, with the primary clinical outcomes being endotracheal intubation or death within 7 days and mortality within 28 and 90 days.

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HFNO demonstrated economic neutrality in non-COVID-19 ARF groups compared to NIV. No economic advantage was seen for COVID-19 patients.

The economic analysis of RENOVATE trial data included 1716 participants with ARF (883 HFNO and 883 NIV): 485 who were nonimmunocompromised with hypoxemia, 77 with COPD exacerbations with respiratory acidosis; 272 with acute cardiogenic pulmonary edema, and 882 patients who were hypoxemic with COVID-19.

Overall, 90-day hospital costs varied among subgroups. For NIV, patients with cardiogenic edema had costs of $22,711, and those with COVID-19 had costs of $72,856. For the HFNO group, the costs were $20,218 and $77,245, respectively.

Among 3 groups, a potential cost reduction was observed with the use of HFNO vs NIV: –$5105 for patients nonimmunocompromised with hypoxemia, –$1267 for those with COPD, and –$2493 for those with cardiogenic edema. However, the hypoxemic COVID-19 group had an incremental cost of $4388 when HFNO was used. For the groups that saw savings with HFNO use, nonimmunocompromised patients with hypoxemia had the highest financial benefit for using HFNO, and the COPD group with respiratory acidosis had the lowest effect.

In a probabilistic sensitivity analysis in the nonimmunocompromised hypoxemia group, the mean HFNO cost was $42,515 with an incremental cost compared with NIV of –$5,663, including –$51,257 at the 2.5th percentile to +$41,378 at the 97.5th percentile. For patients with COPD exacerbations with respiratory acidosis, HFNO had a mean cost of $42,504 with a mean incremental cost of –$520 compared with NIV, with high uncertainty, ranging from –$49,088 to +$76,636.

The factors with the greatest effect on incremental cost between HFNO and NIV were intubation rates, mortality rates, and intensive care unit length of stay, according to the univariate sensitivity analysis. This was observed for all subgroups, including COVID-19.

"HFNO demonstrated economic neutrality in non-COVID-19 ARF groups compared to NIV. No economic advantage was seen for COVID-19 patients," the study authors concluded, adding that "Cost-effectiveness should be considered alongside patient-specific clinical factors for optimal treatment decisions."

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FDA Approves Endovascular Catheter For The Treatment Of Acute Pulmonary ...

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Temple University announced that a endovascular catheter, invented at its Lewis Katz School of Medicine and developed by Thrombolex, has been approved by the FDA for treatment of acute pulmonary embolism.

The approval is based on the results from the RESCUE study, published in JACC: Cardiovascular Interventions, for which the endovascular catheter (Bashir) was associated with greater reductions in lung artery obstruction compared with existing therapies for PE and achieved this effect in a shorter duration of treatment, according to a press release.

The small catheter features a basket of six miniature infusion catheters that can be expanded within a clot in a large blood vessel to open new channels for blood to flow into the clot. According to the release, this also creates more surface area for exposure to clot-dissolving medication that can be administered via the six miniature infusion catheters.

Riyaz Bashir

"This U.S. FDA approval is a significant milestone in acute pulmonary embolism treatment. It marks the availability of a very safe and a highly effective treatment that can be delivered rapidly (within 15 minutes) at most of the hospitals around the globe," Riyaz Bashir, MD, FACC, professor of medicine at the Katz School of Medicine and director of vascular and endovascular medicine at Temple University Hospital, and co-inventor of the endovascular catheter, said in the release.

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