Cost-effectiveness of inhaled nitric oxide for the management of persistent pulmonary hypertension of the newborn.
OBJECTIVE
Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that has become part of the standard management for persistent pulmonary hypertension of the newborn (PPHN). This treatment modality, like many in neonatology, has not been well studied using quantitative economic techniques. The objective of this study was to evaluate the economic impact of adding iNO to the treatment protocol of PPHN for term infants from birth to the time of discharge from their initial hospitalization.


METHODS
We used decision analysis modeling from a societal perspective to obtain an incremental cost-effectiveness ratio. Outcome probabilities were taken from the medical literature and a cohort of 123 infants who were treated with PPHN at The Children's Hospital of Philadelphia between 1991 and 2002. Costs were estimated from daily resources used by these infants in 2001 dollars. Survival and quality-adjusted life years were used as effectiveness measures. One-way, threshold, and probabilistic sensitivity analyses were performed to assess the robustness of the base-case estimate.


RESULTS
The addition of iNO to the treatment regimen of PPHN increased the cost of treating an infant by an average of 1141 dollars, primarily from an increased number of mechanical ventilation days. Use of iNO led to 3.4% more lives saved and a 6% increase in the average utility gained per infant. The incremental cost-effectiveness ratio was 33,234 dollars per life saved and 19,022 dollars per quality-adjusted life year gained. The model was robust to changes in outcome probabilities, cost, and utility variables. Only 3.6% of the trials using probabilistic sensitivity analysis found iNO to be more expensive with a worse outcome than conventional therapy alone, whereas 35.7% of the trials found iNO to be cheaper and more effective than conventional treatment alone.


CONCLUSIONS
iNO is cost-effective but not cost-saving in treating infants with PPHN from a societal perspective. There are critical time points during an infant's hospitalization that could improve the efficiency and consequently the cost of care for this patient population.
Department of Pediatrics, Center for Outcomes Research, Children's Hospital of Philadelphia, 3535 Market St, Ste 1029, Philadelphia, Pennsylvania 19104, USA. lorch@email.chop.edu
Scott A
SA
Lorch
Avital
A
Cnaan
Kurt
K
Barnhart
D000280:Administration, Inhalation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D009569:Nitric Oxide / Q000191:economics* / Q000627:therapeutic use*; D010547:Persistent Fetal Circulation Syndrome / Q000191:economics / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D009569:Nitric Oxide