Early high-flow nasal oxygen therapy in paediatric acute hypoxaemic respiratory failure: a cost analysis following a randomised controlled trial

OBJECTIVE: To compare the total direct healthcare costs of nasal high flow (NHF) therapy and standard oxygen therapy (SOT) as first-line treatments for paediatric acute hypoxaemic respiratory failure (AHRF) and to identify what factors explain variations in these costs. DESIGN: Cost analysis following a randomised controlled trial. SETTING: 14 hospitals across Australia and New Zealand. PATIENTS: 1517 children aged 1-4 years admitted with AHRF between 18 December 2017 and 18 March 2020, enrolled in the Paediatric Acute Respiratory Intervention Study 2(PARIS-2) trial. INTERVENTIONS: Patients were randomised to receive either NHF or SOT. MAIN OUTCOME MEASURES: Total and average cost per patient admission for the two first-line treatments of AHRF. RESULTS: The total cost of treating the trial cohort was $A10 788 793 (US$7 660 143; €6 689 052; £6 041 724), corresponding to an average of $A7112 (US$5050; €4409; £3983) per patient. Average cost per patient admission was significantly higher in the NHF group at $A7815 (US$5549; €4845; £4376) compared with the SOT group at $A6419 (US$4557; €3980; £3595), with a mean difference of $A1396 (US$991; €866; £782, 95% CI $A419 to $A2372). Subgroup analyses showed that NHF non-responders, particularly those presenting with wheeze, incurred greater costs due to higher likelihood of intensive care admission and longer hospital stays. CONCLUSION: NHF costs more than SOT and does not lead to better clinical outcomes. Although NHF remains an important respiratory support modality for paediatric AHRF, its higher costs, particularly among those not responding to NHF, emphasise the need for more targeted use. TRIAL REGISTRATION NUMBER: ACTRN12618000210279.