Coste-efectividad de la oxigenoterapia de alto flujo en el tratamiento de la neumonía por SARS-CoV-2

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES
A. González-Castro , E. Cuenca Fito , A. Fernandez , Y. Peñasco , V. Modesto i Alport , A. Medina Villanueva , A. Fajardo , P. Escude-Acha
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引用次数: 0

Abstract

Introduction

high-oxygen nasal cannulas in patients with respiratory failure secondary to SARS-CoV-2 pneumonia have not been studied from a cost-effectiveness point of view.

Methods

Retrospective analysis of patients who had entered the COVID-area of an intensive medicine service in a third reference hospital, between March-December 2020. An effectiveness cost analysis was carried out comparing 2 therapeutic decisions: the experimental strategy was defined as a mixed strategy consisting of the initial application of high flow nasal oxygen (HFNO) and application of VMI only to HFNO failures. The optimal rational decision was defined as maximizing expected profit, and economic efficiency was assessed by calculating the Incremental Cost-Effectiveness Ratio (ICER) for years of life gained.

Results

Of the 185 patients tested, 101 (55%) received invasive mechanical ventilation immediately and 84 (45%) were treated with HFNO at the outset. In the cost-effectiveness analysis, comparing both therapeutic strategies, the probability that the experimental strategy would be more effective was 0.974, reaching statistical significance: Difference in average proportions -0.113; 95% CI:-0.018 to -0.208. This corresponds to an NNT of 9 patients. The optimal decision was HFNO's strategy followed by VMI in HFNO failures. This option had an RCEI of 5582 euros per year of life gained.

Conclusions

It is important to establish in the future reliable markers in the use of HFNO so that this therapy improves its cost-effective benefits.

大流量氧疗治疗SARS-CoV-2肺炎的成本-效果
引言从成本效益的角度来看,尚未对严重急性呼吸系统综合征冠状病毒2型肺炎继发呼吸衰竭患者的高氧鼻插管进行研究。方法对2020年3月至12月期间进入第三家参考医院重症监护室的新冠肺炎患者进行回顾性分析。对两种治疗决策进行了有效性成本分析:实验策略被定义为一种混合策略,包括最初应用高流量鼻氧(HFNO)和仅应用VMI治疗HFNO失败。最优理性决策被定义为最大化预期利润,并通过计算所获得寿命年的增量成本效益比(ICER)来评估经济效率。结果185例患者中,101例(55%)立即接受有创机械通气,84例(45%)一开始接受HFNO治疗。在成本效益分析中,比较两种治疗策略,实验策略更有效的概率为0.974,达到统计学显著性:平均比例差异-0.113;95%可信区间:-0.018至-0.208。这相当于9名患者的NNT。在HFNO故障中,最优决策是HFNO的策略,然后是VMI。这一选择每年可获得5582欧元的RCEI。结论重要的是在未来建立可靠的HFNO使用标志物,以提高该疗法的成本效益。
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来源期刊
CiteScore
1.70
自引率
8.30%
发文量
83
审稿时长
57 days
期刊介绍: Revista de Calidad Asistencial (Quality Healthcare) (RCA) is the official Journal of the Spanish Society of Quality Healthcare (Sociedad Española de Calidad Asistencial) (SECA) and is a tool for the dissemination of knowledge and reflection for the quality management of health services in Primary Care, as well as in Hospitals. It publishes articles associated with any aspect of research in the field of public health and health administration, including health education, epidemiology, medical statistics, health information, health economics, quality management, and health policies. The Journal publishes 6 issues, exclusively in electronic format. The Journal publishes, in Spanish, Original works, Special and Review Articles, as well as other sections. Articles are subjected to a rigorous, double blind, review process (peer review)
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