[Cost effectiveness and budget impact analysis of inhaled nitric oxide in a neonatal unit from the perspective of the public health system].
Inhaled nitric oxide (iNO) is currently the first-line therapy in severe hypoxaemic respiratory failure of the newborn. Most of regional neonatal centres in Chile do not have this therapeutic alternative.



To determine the cost effectiveness of inhaled nitric oxide in the treatment of respiratory failure associated with pulmonary hypertension of the newborn compared to the usual care, including the transfer to a more complex unit.



A clinical decision tree was designed from the perspective of Chilean Public Health Service. Incremental cost effectiveness rates (ICER) were calculated, deterministic sensitivity analysis was performed, and probabilistic budget impact was estimated using: TreeAge Pro Healthcare 2014 software.



The iNO option leads to an increase in mean cost of $ 11.7 million Chilean pesos (€15,000) per patient treated, with an ICER compared with the usual care of $23 million pesos (€30,000) in case of death or ECMO avoided. By sensitising the results by incidence, it was found that from 7 cases and upwards treated annually, inhaled nitric oxide is less costly than the transfer to a more complex unit.



From the perspective of a Chilean regional hospital, incorporating inhaled nitric oxide into the management of neonatal respiratory failure is the optimal alternative in most scenarios.
Servicio de Neonatología, Hospital Dr. Hernán Henríquez Aravena, Temuco, Chile; Facultad de Medicina, Escuela de Obstetricia y Puericultura, Universidad Mayor, Temuco, Chile. Electronic address: carlos.kilchemmann@mayor.cl.
Carlos
C
Kilchemmann Fuentes
Facultad de Medicina, Departamento de Obstetricia y Ginecología, Universidad de la Frontera, Temuco, Chile; Centro de Excelencia Capacitación, Investigación y Gestión para la Salud basada en Evidencias (CIGES), Universidad de la Frontera, Temuco, Chile.
Carlos
C
Vallejos Vallejos
Servicio de Neonatología, Hospital Dr. Hernán Henríquez Aravena, Temuco, Chile; Centro de Excelencia Capacitación, Investigación y Gestión para la Salud basada en Evidencias (CIGES), Universidad de la Frontera, Temuco, Chile; Facultad de Medicina, Departamento de Pediatría y Cirugía Infantil, Universidad de la Frontera, Temuco, Chile.
Andrés
A
Román Navarro
D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000191:economics; D002017:Budgets; D002677:Chile; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006760:Hospitalization / Q000191:economics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D007231:Infant, Newborn; D009359:Neonatology / Q000191:economics; D009569:Nitric Oxide / Q000008:administration & dosage* / Q000191:economics; D010360:Patient Transfer / Q000191:economics; D011634:Public Health / Q000191:economics; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000191:economics / Q000209:etiology
D001993:Bronchodilator Agents; D009569:Nitric Oxide
Análisis costo-efectividad; Cost-benefit analysis; Hipertensión pulmonar persistente; Insuficiencia respiratoria; Nitric oxide; Persistent foetal circulation syndrome; Respiratory insufficiency; Óxido nítrico