ArticlePLOS global public health2026
A cost-consequence analysis of the children's administration oxygenation strategies trial (COAST) in severe pneumonia.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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.
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.
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Who cites it
1 citing paper in PubMed.
- Implementation of an Institutional Asthma Care Guideline in Hospitalized Children: Effects on Clinical Outcomes and Healthcare Resource Utilization.Journal of asthma and allergy · 2026Article
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Oxygen supplementation is a recommended treatment for children with severe pneumonia or hypoxaemia. The open, fractional-factorial Children's Oxygen Administration Strategies Trial (COAST) recruited Kenyan and Ugandan children with severe pneumonia and hypoxaemia. Participants in the severe hypoxaemia stratum (SpO2 < 80%) were randomised to high-flow nasal therapy (HFNT) or low-flow oxygen (LFO), and in the hypoxaemia stratum (SpO2 80-91%) to HFNT, LFO or permissive hypoxaemia (ratio 1:1:2). The trial stopped early and there is ongoing uncertainty about the clinical benefits of the alternative strategies. There is a lack of evidence about the relative costs, of alternative oxygen delivery for critically-ill children in low- and middle- income countries. We used data from COAST to conduct a cost-consequence analysis of the treatment strategies. We measured resource use for 28 days post-randomisation (n = 1,842). Resources included oxygen delivery, medications, blood and fluid products, diagnostic tests, point of care tests, hospital admission and length of stay. We calculated the total costs and reported the incremental costs as the difference in the mean total costs between groups, adjusting for baseline differences. In the severe hypoxaemia stratum, the mean total cost was $393.04 for HFNT and $218.73 for LFO. In the hypoxemia stratum, the mean total costs were $391.95 (HFNT), $198.26 (LFO) and $167.80 (permissive). The adjusted cost difference between HFNT versus LFO and liberal versus permissive was $184.43 (95% CI l: $127.90, $240.95), and $124.01 (95% CI: $99.53, $148.49), respectively. The differences of HFNT and LFO versus permissive were $216.22 (95% CI: $160.77, $271.68) and $31.80 (95% CI: $11.49, $52.11), respectively. For children with severe hypoxaemia, HFNT is more costly than LFO. For children with hypoxaemia, either of HFNT or LFO were more costly than permissive hypoxaemia. The main driver of costs for HFNT is the high cost of equipment and consumables; other costs were similar across treatment groups in both strata, as were health outcomes.
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Registered trials
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