scholarly journals The clinical effectiveness and cost-effectiveness of heated humidified high-flow nasal cannula compared with usual care for preterm infants: systematic review and economic evaluation

2016 ◽  
Vol 20 (30) ◽  
pp. 1-68 ◽  
Author(s):  
Nigel Fleeman ◽  
James Mahon ◽  
Vickie Bates ◽  
Rumona Dickson ◽  
Yenal Dundar ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Usual Care ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Secondary Analysis ◽  
Clinical Effectiveness ◽  
High Flow ◽  
High Flow Nasal Cannula ◽  
Primary Analysis ◽  
The Cost

BackgroundRespiratory problems are one of the most common causes of morbidity in preterm infants and may be treated with several modalities for respiratory support such as nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive-pressure ventilation. The heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity in clinical practice.ObjectivesTo address the clinical effectiveness of HHHFNC compared with usual care for preterm infants we systematically reviewed the evidence of HHHFNC with usual care following ventilation (the primary analysis) and with no prior ventilation (the secondary analysis). The primary outcome was treatment failure defined as the need for reintubation (primary analysis) or intubation (secondary analysis). We also aimed to assess the cost-effectiveness of HHHFNC compared with usual care if evidence permitted.Data sourcesThe following databases were searched: MEDLINE (2000 to 12 January 2015), EMBASE (2000 to 12 January 2015), The Cochrane Library (issue 1, 2015), ISI Web of Science (2000 to 12 January 2015), PubMed (1 March 2014 to 12 January 2015) and seven trial and research registers. Bibliographies of retrieved citations were also examined.Review methodsTwo reviewers independently screened all titles and abstracts to identify potentially relevant studies for inclusion in the review. Full-text copies were assessed independently. Data were extracted and assessed for risk of bias. Summary statistics were extracted for each outcome and, when possible, data were pooled. A meta-analysis was only conducted for the primary analysis, using fixed-effects models. An economic evaluation was planned.ResultsClinical evidence was derived from seven randomised controlled trials (RCTs): four RCTs for the primary analysis and three RCTs for the secondary analysis. Meta-analysis found that only for nasal trauma leading to a change of treatment was there a statistically significant difference, favouring HHHFNC over NCPAP [risk ratio (RR) 0.21, 95% confidence interval (CI) 0.10 to 0.42]. For the following outcomes, there were no statistically significant differences between arms: treatment failure (reintubation < 7 days; RR 0.76, 95% CI 0.54 to 1.09), bronchopulmonary dysplasia (RR 0.92, 95% CI 0.72 to 1.17), death (RR 0.56, 95% CI 0.22 to 1.44), pneumothorax (RR 0.33, 95% CI 0.03 to 3.12), intraventricular haemorrhage (grade ≥ 3; RR 0.41, 95% CI 0.15 to 1.15), necrotising enterocolitis (RR 0.41, 95% CI 0.15 to 1.14), apnoea (RR 1.08, 95% CI 0.74 to 1.57) and acidosis (RR 1.16, 95% CI 0.38 to 3.58). With no evidence to support the superiority of HHHFNC over NCPAP, a cost-minimisation analysis was undertaken, the results suggesting HHHFNC to be less costly than NCPAP. However, this finding is sensitive to the lifespan of equipment and the cost differential of consumables.LimitationsThere is a lack of published RCTs of relatively large-sized populations comparing HHHFNC with usual care; this is particularly true for preterm infants who had received no prior ventilation.ConclusionsThere is a lack of convincing evidence suggesting that HHHFNC is superior or inferior to usual care, in particular NCPAP. There is also uncertainty regarding whether or not HHHFNC can be considered cost-effective. Further evidence comparing HHHFNC with usual care is required.Study registrationThis review is registered as PROSPERO CRD42015015978.FundingThe National Institute for Health Research Health Technology Assessment programme.

Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis

2019 ◽  
Vol 35 (4) ◽  
pp. 298-306 ◽  
Author(s):  
Nigel Fleeman ◽  
Yenal Dundar ◽  
Prakesh S Shah ◽  
Ben NJ Shaw
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Primary Outcome ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Cochrane Library ◽  
High Flow Nasal Cannula ◽  
Safe Alternative

AbstractBackgroundHeated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as a mode of respiratory support. We updated a systematic review and meta-analyses examining the efficacy and safety of HHHFNC compared with standard treatments for preterm infants. The primary outcome was the need for reintubation for preterm infants following mechanical ventilation (post-extubation analysis) or need for intubation for preterm infants not previously intubated (analysis of primary respiratory support)MethodsWe searched PubMed, MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of HHHFNC versus standard treatments. Meta-analysis was conducted using Review Manager 5.3.ResultsThe post-extubation analysis included ten RCTs (n = 1,201), and the analysis of primary respiratory support included ten RCTs (n = 1,676). There were no statistically significant differences for outcomes measuring efficacy, including the primary outcome. There were statistically significant differences favoring HHHFNC versus nasal cannula positive airway pressure (NCPAP) for air leak (post-extubation, risk ratio [RR] 0.29, 95 percent confidence interval [CI] 0.11 to 0.76, I2 = 0) and nasal trauma (post-extubation: 0.35, 95 percent CI 0.27 to 0.46, I2 = 5 percent; primary respiratory support: RR 0.52, 95 percent CI 0.37 to 0.74; I2 = 27 percent). Studies, particularly those of primary respiratory support, included very few preterm infants with gestational age (GA) <28 weeks.ConclusionsHHHFNC may offer an efficacious and safe alternative to NCPAP for some infants but evidence is lacking for preterm infants with GA ≤28 weeks.

Systematic review of high-flow nasal cannula versus continuous positive airway pressure for primary support in preterm infants

2021 ◽  
pp. fetalneonatal-2020-321094
Author(s):  
Shaam Bruet ◽  
Marine Butin ◽  
Frederic Dutheil
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Treatment Failure ◽  
Preterm Infants ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
High Flow ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Nasal Trauma

IntroductionWe conducted a meta-analysis of trials that compared efficacy and safety of high-flow nasal cannula (HFNC) with continuous positive airway pressure (CPAP) as primary respiratory support in preterm infants and a study of the impact of clinical relevant parameters.MethodsDatabases were searched for randomised controlled trials comparing HFNC with CPAP as primary respiratory support in preterm infants. Treatment failure was considered as primary outcome and adverse events as secondary outcomes. We calculated risk ratios (RRs) in intention-to-treat analysis and random-effects meta-analyses of risks were conducted.ResultsWe included 10 studies for a total of 1830 patients. Meta-analysis demonstrated an RR of treatment failure multiplied by 1.34 using HFNC compared with CPAP (RR=1.34, 95% CI 1.01 to 1.68, I2=16.2%). Secondary outcome meta-analysis showed no difference in intubation rates (RR=0.90, 95% CI 0.66 to 1.15) and a lower rate of nasal trauma using HFNC compared with CPAP (RR=0.48, 95% CI 0.31 to 0.65, I²=0.0%). Meta-regressions did not show any influence of gestational age and weight at birth, HFNC flow rate, type of CPAP generator or use of surfactant.ConclusionsDespite a higher risk of treatment failure, considering no difference in intubation rates and a lower rate of nasal trauma using HFNC compared with CPAP, we suggest that HFNC should be used as primary respiratory support in preterm infants.

Safety and efficacy of high-flow nasal cannula therapy in preterm infants: A systematic review and meta-analysis

2015 ◽  
Author(s):  
Mallinath Chakraborty ◽  
Sarah Kotecha ◽  
Roshan Adappa ◽  
Nakul Gupta ◽  
William Watkins ◽  
...  
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Safety And Efficacy

scholarly journals A systematic review and economic evaluation of exercise referral schemes in primary care: a short report

2015 ◽  
Vol 19 (60) ◽  
pp. 1-110 ◽  
Author(s):  
Fiona Campbell ◽  
Mike Holmes ◽  
Emma Everson-Hock ◽  
Sarah Davis ◽  
Helen Buckley Woods ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Sensitivity Analysis ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Clinical Effectiveness ◽  
Chd Risk Factors ◽  
The Cost ◽  
Exercise Referral

BackgroundIt is estimated that only 39% of men and 29% of women in England achieve the levels of physical activity that are recommended to protect health and prevent disease. One approach to addressing this problem has been the development of exercise referral schemes (ERSs), in which health professionals refer patients to external exercise providers. These schemes have been widely rolled out across the UK despite concerns that they may not produce sustained changes in levels of physical activity and, therefore, may not be cost-effective interventions. The evidence to determine clinical effectiveness and cost-effectiveness was evaluated in 2009. This review seeks to update this earlier work by incorporating new evidence and re-examining the cost-effectiveness.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of ERSs compared with usual care.DesignExhaustive searches of relevant electronic databases and journals were undertaken to identify new studies evaluating ERSs using a randomised controlled trial (RCT) design. RCTs that incorporated a qualitative evaluation of the intervention were identified in order to explore the barriers and facilitators to the uptake of and adherence to ERSs. Data were extracted using a previously designed tool and study quality assessed for potential bias. Where data could be pooled, meta-analyses were carried out. Qualitative analysis was also undertaken using a thematic approach. The cost-effectiveness was evaluated using a Markov structure which estimated the likelihood of becoming physically active and the subsequent risk reduction on coronary heart disease (CHD), stroke and type 2 diabetes mellitus. The model adopts a lifetime horizon, and a NHS and Personal Social Services perspective was taken with discounting at 1.5% for both costs and benefits.ResultsThe search identified one new RCT and one new qualitative study. The new data were pooled with existing data from the 2011 review by Paveyet al.[Pavey TG, Anokye N, Taylor AH, Trueman P, Moxham T, Fox KR,et al.The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation.Health Technol Assess2011;15(44)] to give a total of eight studies with 5190 participants. The proportion of individuals achieving 90–150 minutes of at least moderate-intensity activity per week at 6–12 months’ follow-up was greater for ERSs than usual care (relative risk 1.12; 95% confidence interval 1.04 to 1.20). Older patients and those referred for CHD risk factors appeared to be more likely than others to increase their levels of physical activity. Qualitative evidence suggests that interventions enabling the development of social support networks are beneficial in promoting uptake and adherence. Exercise referral gained 0.003 quality-adjusted life-years (QALYs) at an additional cost of £225 per person. The estimated mean incremental cost-effectiveness ratio (ICER) in the probabilistic sensitivity analysis was £76,276. In the univariate sensitivity analysis the results were very sensitive (ICERs ranged from < £30,000 to > £100,000) to changes in the effect of ERSs on physical activity uptake and the duration of the protective effects and the direct health-related quality-of-life gains attributable to physical activity.ConclusionsExercise referral schemes result in a small improvement in the number of people who increase their levels of physical activity. The cost-effectiveness analysis indicates that the ICER for ERSs compared with usual care is around £76,000 per QALY, although the cost-effectiveness of ERSs is subject to considerable uncertainty.Study registrationThis study is registered as PROSPERO CRD42013005200.FundingNational Institute for Health Research Health Technology Assessment programme.

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

PEDIATRICS ◽  
2015 ◽  
Vol 136 (3) ◽  
pp. 542-553 ◽  
Author(s):  
S. J. Kotecha ◽  
R. Adappa ◽  
N. Gupta ◽  
W. J. Watkins ◽  
S. Kotecha ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Safety And Efficacy
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