Cost-Utility of Continuous Positive Airway Pressure for Respiratory Distress in Preterm Infants in a Middle-Income Country

Objectives: Despite the increased popularity of continuous positive airway pressure (CPAP) for preterm infants with respiratory distress, there is still uncertainty about whether the additional costs of this device justify the clinical benefits provided. This study aims to evaluate the cost-utility of CPAP in spontaneously breathing preterm infants with respiratory distress. Methods: Using a decision tree model, we estimated the cost and quality-adjusted life-years (QALYs) associated with CPAP and supplemental oxygen alone by headbox or low-flow nasal cannula (SO). The model was analyzed probabilistically, and a value of information analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base. Cost-effectiveness was evaluated at a willingness-to-pay value of US$5180. Results: The mean incremental cost of CPAP versus SO was US$600. The mean incremental benefit of CPAP versus SO was 0.04 QALY. The expected incremental cost per QALY was estimated at US$13 172. The mean incremental net monetary benefit was US$-324 with a 95% credible interval of US$-536 to US$-201. The overall expected value of perfect information per person affected by the decision was estimated to be US$2346. Conclusions: Compared with SO, the use of CPAP in spontaneously breathing preterm infants with respiratory distress is not cost-effective in Colombia. Evidence should continue to be generated with real-life effectiveness data and economic evaluations in other countries to confirm our findings.

Automated summary

This study aims to evaluate the cost-utility of continuous positive airway pressure (CPAP) in preterm infants with respiratory distress. The results show that compared to supplemental oxygen alone, CPAP has an incremental cost of $600 with an incremental benefit of 0.04 QALY. The cost per QALY is estimated at $13,172. Overall, the use of CPAP in spontaneously breathing preterm infants with respiratory distress is not cost-effective in Colombia.