Abstract
Objective:
To determine the cost-effectiveness of nasal continuous positive pressure (nCPAP) compared with nasal intermittent positive pressure ventilation (NIPPV) in the context of the reported randomized clinical trial.
Study Design:
Using patient-level data from the clinical trial, we undertook a prospectively planned economic evaluation. We measured costs, from a third-party payer perspective in all patients, and from a societal perspective in a subgroup with a time horizon through the earlier of discharge, death or 44 weeks post-menstrual age.
Results:
From the third-party payer perspective, the mean cost of hospitalization per infant was statistically similar, $143 745 in the NIPPV group compared to $140 403 in the nCPAP group. Cost-effectiveness evaluation revealed a 61% probability that NIPPV is more expensive and less effective than nCPAP. Similar results were found in subgroup analysis from a societal perspective.
Conclusion:
In addition to being clinically equivalent, economic evaluation confirms that NIPPV, as employed in this trial, is also not economically favorable.
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Acknowledgements
Economic evaluation supported in part by UF CTSI Advanced Postgraduate Program in Clinical Investigation (NIH & NCRR CTSA grant UL1 TR000064); NIPPV trial supported by Canadian Institutes of Health Research (MCT-80246).
Author contributions
Meredith E Mowitz, MD MS: Dr Mowitz coordinated the analysis, interpreted the results, drafted the initial manuscript and approved the final manuscript as submitted. John A F Zupancic, MD ScD: Dr Zupancic conceptualized the study, designed the data collection tools, assisted with the analysis, reviewed the manuscript and approved the final manuscript as submitted. David Millar, MB: Dr Millar was involved in the clinical trial, reviewed the manuscript and approved the final manuscript as submitted. Haresh Kirpalani, MD MSc: Dr Kirpalani was the PI for the clinical trial, reviewed the manuscript and approved the final manuscript as submitted. Jessica S Gaulton, MD MPH: Dr Gaulton assisted in the analysis of the societal cost prospective, reviewed the manuscript and approved the final manuscript as submitted. Robin S Roberts, MSc & Wenyang Mao MS: Mr. Roberts and Ms. Mao provided the statistical analyses, reviewed the manuscript and approved the final manuscript as submitted. Dmitry Dukhovny, MD MPH: Dr Dukhovny conceptualized and designed the data collection tools and data analysis, reviewed the manuscript and approved the final manuscript as submitted.
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Mowitz, M., Zupancic, J., Millar, D. et al. Prospective economic evaluation alongside the non-invasive ventilation trial. J Perinatol 37, 61–66 (2017). https://doi.org/10.1038/jp.2016.159
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DOI: https://doi.org/10.1038/jp.2016.159
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