Evidence map›Paper›PMID 39587649›Full record

Trial reportCritical care (London, England)2024

Cost-effectiveness of high flow nasal cannula therapy versus continuous positive airway pressure for non-invasive respiratory support in paediatric critical care.

Zia Sadique, Silvia Moler Zapata, Richard Grieve, Alvin Richards-Belle, Izabella Lawson, Robert Darnell, Julie Lester, Kevin P Morris, Lyvonne N Tume, Peter J Davis and 8 more

Abstract readComparative StudyEquivalence TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Zia SadiqueHealth Economics, Department of Health Services Research and Policy, Public Health and Policy Faculty, London School of Hygiene and Tropical Medicine, London, UK. zia.sadique@lshtm.ac.uk.
Silvia Moler ZapataHealth Economics, Department of Health Services Research and Policy, Public Health and Policy Faculty, London School of Hygiene and Tropical Medicine, London, UK.
Richard GrieveHealth Economics, Department of Health Services Research and Policy, Public Health and Policy Faculty, London School of Hygiene and Tropical Medicine, London, UK.
Alvin Richards-BelleClinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK.
Izabella LawsonCancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Robert DarnellClinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK.
Julie LesterParent Representative, Sussex, UK.
Kevin P MorrisBirmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
Lyvonne N TumeFaculty of Health Social Care & Medicine, Edge Hill University, Lancashire, UK.
Peter J DavisPaediatric Intensive Care Unit, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Mark J PetersPaediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR Biomedical Research Centre, London, UK.
Richard G FeltbowerLeeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK.
Paul R MounceyClinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK.
David A HarrisonClinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK.
Kathryn M RowanClinical Trials Unit, Intensive Care National Audit & Research Centre, London, UK.
Padmanabhan RamnarayanSection of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. p.ramnarayan@imperial.ac.uk.
FIRST-ABC RCT Investigators
Paediatric Critical Care Society Study Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHigh flow nasal cannula therapy (HFNC) and continuous positive airway pressure (CPAP) are two widely used modes of non-invasive respiratory support in paediatric critical care units. The FIRST-ABC randomised controlled trials (RCTs) evaluated the clinical and cost-effectiveness of HFNC compared with CPAP in two distinct critical care populations: acutely ill children ('step-up' RCT) and extubated children ('step-down' RCT). Clinical effectiveness findings (time to liberation from all forms of respiratory support) showed that HFNC was non-inferior to CPAP in the step-up RCT, but failed to meet non-inferiority criteria in the step-down RCT. This study evaluates the cost-effectiveness of HFNC versus CPAP.

methodsAll-cause mortality, health-related Quality of Life (HrQoL), and costs up to six months were reported using FIRST-ABC RCTs data. HrQoL was measured with the age-appropriate Paediatric Quality of Life Generic Core Scales questionnaire and mapped onto the Child Health Utility 9D index score at six months. Quality-Adjusted Life Years (QALYs) were estimated by combining HrQoL with mortality. Costs at six months were calculated by measuring and valuing healthcare resources used in paediatric critical care units, general medical wards and wider health service. The cost-effectiveness analysis used regression methods to report the cost-effectiveness of HFNC versus CPAP at six months and summarised the uncertainties around the incremental cost-effectiveness results.

resultsIn both RCTs, the incremental QALYs at six months were similar between the randomised groups. The estimated incremental cost at six months was - £4565 (95% CI - £11,499 to £2368) and - £5702 (95% CI - £11,328 to - £75) for step-down and step-up RCT, respectively. The incremental net benefits of HFNC versus CPAP in step-down RCT and step-up RCT were £4388 (95% CI - £2551 to £11,327) and £5628 (95% CI - £8 to £11,264) respectively. The cost-effectiveness results were surrounded by considerable uncertainties. The results were similar across most pre-specified subgroups, and the base case results were robust to alternative assumptions.

conclusionsHFNC compared to CPAP as non-invasive respiratory support for critically-ill children in paediatric critical care units reduces mean costs and is relatively cost-effective overall and for key subgroups, although there is considerable statistical uncertainty surrounding this result.

Indexed as

CannulaContinuous Positive Airway PressureCost-Benefit AnalysisChild, PreschoolCritical CareFemaleHumansInfantIntensive Care Units, PediatricMaleNoninvasive VentilationOxygen Inhalation TherapyQuality-Adjusted Life YearsQuality of LifeContinuous positive airway pressureCost-effectivenessHigh-flow nasal cannulaIncremental net benefitNon-invasive respiratory supportPaediatric critical care

Identifiers

PMID39587649
PMCPMC11587665

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.