Exploring Heterogeneity in Cost-Effectiveness Using Machine Learning Methods

A Case Study Using the FIRST-ABC Trial

Bibliographic Data

ID9101341
AuthorsZaid Hattab (0000-0003-1139-2030, Discipline of Economics, University of Galway, Galway, Ireland, corresponding author), Erin Doherty (0000-0001-8756-8974, Ollscoil na Gaillimhe – University of Galway, corresponding author), Edel Doherty (Discipline of Economics, University of Galway, Galway, Ireland), Zia Sadique (0000-0001-5814-0258, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK), Padmanabhan Ramnarayan (0000-0003-0784-8154, Imperial College London), Stephen O’neill (0000-0002-0022-0500, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK)
Year2024
Volume62
Issue7
Pages449-457
Publication date2024-07-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000002010
PMID38848138
OpenAlexW4399429069
LanguageEN
References cited36

OBJECTIVE: The aim of this study was to explore heterogeneity in the cost-effectiveness of high-flow nasal cannula (HFNC) therapy compared with continuous positive airway pressure (CPAP) in children following extubation. DESIGN: Using data from the FIRST-line support for Assistance in Breathing in Children (FIRST-ABC) trial, we explore heterogeneity at the individual and subgroup levels using a causal forest approach, alongside a seemingly unrelated regression (SUR) approach for comparison. SETTINGS: FIRST-ABC is a noninferiority randomized controlled trial (ISRCTN60048867) including children in UK paediatric intensive care units, which compared HFNC with CPAP as the first-line mode of noninvasive respiratory support. PATIENTS: In the step-down FIRST-ABC, 600 children clinically assessed to require noninvasive respiratory support were randomly assigned to HFNC and CPAP groups with 1:1 treatment allocation ratio. In this analysis, 118 patients were excluded because they did not consent to accessing their medical records, did not consent to follow-up questionnaire or did not receive respiratory support. MEASUREMENTS AND MAIN RESULTS: The primary outcome of this study is the incremental net monetary benefit (INB) of HFNC compared with CPAP using a willingness-to-pay threshold of £20,000 per QALY gain. INB is calculated based on total costs and quality adjusted life years (QALYs) at 6 months. The findings suggest modest heterogeneity in cost-effectiveness of HFNC compared with CPAP at the subgroup level, while greater heterogeneity is detected at the individual level. CONCLUSIONS: The estimated overall INB of HFNC is smaller than the INB for patients with better baseline status suggesting that HFNC can be more cost-effective among less severely ill patients

Cannula · Confidence interval · Continuous positive airway pressure · Nasal cannula · Randomized controlled trial · Subgroup analysis · Emergency Medicine · Health Systems, Economic Evaluations, Quality of Life · Internal Medicine · Medicine · Neonatal Respiratory Health Research · Respiratory Support and Mechanisms · Surgery

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