Objectives
Respiratory distress syndrome (RDS) is relatively common in preterm neonates due to lung immaturity. Clinical management by respiratory support is associated with high complications rates. Guidance on appropriate lung-aeration is limited using conventional thorax X-ray monitoring. Electrical impedance tomography (EIT) allows radiation-free, continuous lung-aeration monitoring to guide effective respiratory support. EIT produces dynamic images of air volume changes whereas X-ray shows 2-D structure. Clinicians expect EIT implementation to reduce the number of patients requiring mechanical ventilation, overall complication rates and hospitalisation length. We conducted an early cost-effectiveness analysis of EIT-monitoring in preterm neonates with RDS versus standard care in the Netherlands.
Methods
A decision-analytic model was constructed comparing costs and effects of conventional X-ray versus EIT-monitoring for preterm neonates with RDS from the healthcare perspective with a time horizon of two years. Input parameters were based on literature and cost databases. The effects of EIT-monitoring were based on consensus by 6 clinical experts for two scenarios, (1) a conservative scenario assuming only a decrease of patients on mechanical ventilation under EIT-monitoring, and (2) an optimistic scenario including scenario (1) and assuming an additional 10% relative complication rate decrease in comparison to standard care. Main outcomes were total average costs per patient, number of patients with bronchopulmonary dysplasia (BPD), and mortality. One-way sensitivity analyses were conducted.
Results
EIT-monitoring was estimated to be cost-saving in both scenarios, mainly due to a shorter average hospital length of stay. Total incremental costs per patient for EIT-monitored care versus standard care were -€929 and -€10,706 for scenario (1) and (2), respectively. The number of patients with BPD and deaths were reduced. Results were robust to changes in input parameters.
Conclusions
EIT lung-aeration monitoring in preterm neonates is expected to result in cost-savings and lower mortality and BPD rates, in comparison to standard care, in a Dutch hospital setting.
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© 2019 Published by Elsevier Inc.
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