title: Inhaled nitric oxide in term/late preterm neonates with hypoxic respiratory failure: estimating the financial impact of earlier use.
abstract: OBJECTIVE
  We reported recently that early use of inhaled nitric oxide therapy (iNO) for term and late preterm infants with hypoxic respiratory failure (HRF) at an oxygenation index (OI) of ≥15 and <20 is associated with earlier discharge from the hospital, relative to babies treated at OI ≥25. The objective of the present analysis is to determine whether earlier use of iNO in this cohort leads to lower cost of medical care.
  
  
  METHODS
  We used a decision-analytic model, which was developed to compare hospital resource use and costs associated with early versus standard use of iNO in HRF. The model population included infants with moderate HRF caused by primary pulmonary hypertension with an OI ≥15 and <20. A hypothetical case population of 1000 patients was assumed and probabilistic sensitivity analyses were completed where all the clinical inputs into the model were varied. Two deterministic sensitivity analyses were also completed, one surrounding the hospital cost inputs and another surrounding the cost of iNO.
  
  
  RESULTS
  Early iNO was associated with fewer hospital days, fewer days of ventilation and fewer hours on extracorporeal membrane oxygenation (ECMO). In probabilistic sensitivity analyses, total costs per patient were $88,518 ± $7574 and $92,581 ± $9664 for early iNO and standard iNO, respectively. The probability of early iNO being cost-effective was approximately 72%, based on a willingness to pay $100,000 or less to prevent ECMO therapy and/or death. In both deterministic sensitivity analyses, early iNO was cost-saving.
  
  
  CONCLUSIONS
  Our analysis shows that early use of iNO at an OI of ≥15 and <20 may be associated with shorter hospitalizations and a decreased cost of care for term/late preterm infants with HRF associated with pulmonary hypertension. Our results are based on clinical data from a single trial; future research using data from real-world practice is warranted.
authors: a a Division of Neonatology, Department of Pediatrics and Children's Research Institute , Medical College of Wisconsin , Milwaukee , WI , USA.
authors: G Ganesh
authors: GG
authors: Konduri
authors: b b Boston Health Economics Inc. , Waltham , MA , USA.
authors: Joseph
authors: J
authors: Menzin
authors: b b Boston Health Economics Inc. , Waltham , MA , USA.
authors: Molly
authors: M
authors: Frean
authors: c c Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , BC , Canada.
authors: Terry
authors: T
authors: Lee
authors: d d Ikaria Inc. , Hampton , NJ , USA.
authors: Jim
authors: J
authors: Potenziano
authors: c c Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , BC , Canada.
authors: Joel
authors: J
authors: Singer
mesh_terms: D000280:Administration, Inhalation; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017059:Models, Econometric; D009569:Nitric Oxide / Q000008:administration & dosage* / Q000191:economics*; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000209:etiology; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000191:economics*
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide
keywords: ECMO; Inhaled nitric oxide; Lung disease