The clinical effectiveness and cost-effectiveness of heated humidified high-flow nasal cannula compared with usual care for preterm infants: systematic review and economic evaluation

• Published in: Health technology assessment (Winchester, England) England), 2016-04, Vol.20 (30), p.1-68
• Main Authors: Fleeman, Nigel, Mahon, James, Bates, Vickie, Dickson, Rumona, Dundar, Yenal, Dwan, Kerry, Ellis, Laura, Kotas, Eleanor, Richardson, Marty, Shah, Prakesh, Shaw, Ben Nj
• Format: Article
• Language: English
• Subjects: Cannula; Catheterization, Peripheral - instrumentation; Catheterization, Peripheral - methods; Continuous Positive Airway Pressure - methods; Cost-Benefit Analysis; heated humidified high-flow nasal cannula; Hot Temperature - therapeutic use; Humans; infant; Infant, Newborn; Infant, Premature; meta-analysis; nasal continuous positive airway pressure; pre-term; premature; randomised controlled trial; Randomized Controlled Trials as Topic; Respiratory Distress Syndrome, Newborn - therapy; Technology Assessment, Biomedical; Treatment Outcome
• ISSN: 1366-5278; 2046-4924
• DOI: 10.3310/hta20300

Respiratory problems are one of the most common causes of morbidity in preterm infants and may be treated with several modalities for respiratory support such as nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive-pressure ventilation. The heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity in clinical practice. To address the clinical effectiveness of HHHFNC compared with usual care for preterm infants we systematically reviewed the evidence of HHHFNC with usual care following ventilation (the primary analysis) and with no prior ventilation (the secondary analysis). The primary outcome was treatment failure defined as the need for reintubation (primary analysis) or intubation (secondary analysis). We also aimed to assess the cost-effectiveness of HHHFNC compared with usual care if evidence permitted. The following databases were searched: MEDLINE (2000 to 12 January 2015), EMBASE (2000 to 12 January 2015), The Cochrane Library (issue 1, 2015), ISI Web of Science (2000 to 12 January 2015), PubMed (1 March 2014 to 12 January 2015) and seven trial and research registers. Bibliographies of retrieved citations were also examined. Two reviewers independently screened all titles and abstracts to identify potentially relevant studies for inclusion in the review. Full-text copies were assessed independently. Data were extracted and assessed for risk of bias. Summary statistics were extracted for each outcome and, when possible, data were pooled. A meta-analysis was only conducted for the primary analysis, using fixed-effects models. An economic evaluation was planned. Clinical evidence was derived from seven randomised controlled trials (RCTs): four RCTs for the primary analysis and three RCTs for the secondary analysis. Meta-analysis found that only for nasal trauma leading to a change of treatment was there a statistically significant difference, favouring HHHFNC over NCPAP [risk ratio (RR) 0.21, 95% confidence interval (CI) 0.10 to 0.42]. For the following outcomes, there were no statistically significant differences between arms: treatment failure (reintubation