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Abstract
Objective Conduct a cost-effectiveness analysis of FreeO2 technology versus manual oxygen-titration technology for patients with chronic obstructive pulmonary disease (COPD) hospitalised for acute exacerbations.
Setting Tertiary acute care hospital in Quebec, Canada.
Participants 47 patients with COPD hospitalised for acute exacerbations.
Intervention An automated oxygen-titration and oxygen-weaning technology.
Methods and outcomes The costs for hospitalisation and follow-up for 180 days were calculated using a microcosting approach and included the cost of FreeO2 technology. Incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap resampling with 5000 replications. The main effect variable was the percentage of time spent at the target oxygen saturation (SpO2). The other two effect variables were the time spent in hyperoxia (target SpO2+5%) and in severe hypoxaemia (SpO2 <85%). The resamplings were based on data from a randomised controlled trial with 47 patients with COPD hospitalised for acute exacerbations.
Results FreeO2 generated savings of 20.7% of the per-patient costs at 180 days (ie, −$C2959.71). This decrease is nevertheless not significant at the 95% threshold (P=0.13), but the effect variables all improved (P<0.001). The improvement in the time spent at the target SpO2 was 56.3%. The ICERs indicate that FreeO2 technology is more cost-effective than manual oxygen titration with a savings of −$C96.91 per percentage point of time spent at the target SpO2 (95% CI −301.26 to 116.96).
Conclusion FreeO2 technology could significantly enhance the efficiency of the health system by reducing per-patient costs at 180 days. A study with a larger patient sample needs to be carried out to confirm these preliminary results.
Trial registration number NCT01393015; Post-results.
- cost-effectiveness
- oxygen-titration
- copd
- bootstrap
- freeo2
- canada
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Footnotes
Contributors TGP, CRCK and FL conceived the study. TGP, PAB and VT collected the data. TGP, CRCK, SB, FM and FL participated to the analysis of data. TGP and CRCK conducted the bootstrap simulations. TGP and CRCK wrote the manuscript. All authors revised and approved the manuscript.
Funding This research received support under Mitacs Acceleration programme. The Mitacs Acceleration programme is cofunded by Innovation, Sciences and Economic Development Canada (ISED) and the industry (Oxynov in this case). The funding body did not influence the study design and analysis.
Disclaimer The funding body did not influence the study design and analysis.
Competing interests FL is the coinventor of the FreeO2 system and cofounder of Oxynov, the firm that developed and productionised the FreeO2 system for marketing. The Fonds de Recherche en Santé du Québec contributes to Dr François Lellouche salary for research activities (clinical research scholar) and to the research assistant’s salary (clinical research grant). FM holds a GlaxoSmithKline/Canadian Institutes of Health Research chair on COPD at Laval University. FM participates in Innovair, a company that owns shares in OxyNov, the owner of the FreeO2 device.
Patient consent Obtained.
Ethics approval The RCT was approved by the Institutional Ethics Committee of the IUCPQ (# 20694), and a signed consent was obtained from each participant.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available on request to the corresponding author.