Document Detail

Cost-effectiveness of inhaled nitric oxide for the management of persistent pulmonary hypertension of the newborn.
MedLine Citation:
PMID:  15286225     Owner:  NLM     Status:  MEDLINE    
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.
Scott A Lorch; Avital Cnaan; Kurt Barnhart
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Pediatrics     Volume:  114     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-08-02     Completed Date:  2004-12-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  417-26     Citation Subset:  AIM; IM    
Department of Pediatrics, Center for Outcomes Research, Children's Hospital of Philadelphia, 3535 Market St, Ste 1029, Philadelphia, Pennsylvania 19104, USA.
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MeSH Terms
Administration, Inhalation
Cost-Benefit Analysis
Decision Support Techniques*
Decision Trees
Extracorporeal Membrane Oxygenation / economics
Infant, Newborn
Nitric Oxide / economics*,  therapeutic use*
Persistent Fetal Circulation Syndrome / economics,  therapy*
Quality-Adjusted Life Years*
Randomized Controlled Trials as Topic
Treatment Outcome
Grant Support
T32 HD-07740-06/HD/NICHD NIH HHS
Reg. No./Substance:
10102-43-9/Nitric Oxide

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