Abstract: Pulse oximetry is a non-invasive technology that is integral to the supportive care of hospitalized infants with bronchiolitis. A multi-centre, randomized trial comparing the effectiveness of intermittent vs. continuous pulse oximetry found similar hospital length of stay and safety outcomes, and greater nursing satisfaction with intermittent monitoring. Objectives To evaluate the cost-effectiveness of intermittent vs. continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis. Design/Methods Prospective economic evaluation concurrent with a randomized trial (October 2016 to May 2019) using a probabilistic analysis. Infants (n=229) 4 weeks to 24 months hospitalized with bronchiolitis, with or without supplemental oxygen, after stabilization were randomized at six Ontario hospitals (community and children's) to intermittent (every 4 hours) vs. continuous pulse oximetry using an oxygen saturation target of 90% or higher. The main outcome measure for the economic evaluation was cost and incremental costs. The clinical effect measure was length of hospital stay in hours. The cost-effective analysis adopted a societal and health care system perspective and a time horizon from hospitalization to 15 days post-discharge. Patient level direct health care costs and indirect costs were included. Costs, health resource use and clinical outcomes were obtained from trial data. Publicly available pricing resources were used to supplement costs. Ranges for sensitivity analysis were based on 95% confidence intervals of the trial data. All costs were reported in 2020 Canadian dollars. This study was funded by a grant from the Canadian Institutes of Health Research. Results Trial data from 229 infants across six hospitals was included. Mean societal costs per patient were lower in the intermittent monitoring group: $6528 (95% CI: $3201, $12058) in the intermittent and $6815 (95% CI: $1454, $26485) in the continuous group with a mean incremental cost of -$287 (95% CI -$20084, $7842). Mean health care system costs per patient were $3992 (95% CI -$1139, $9224) in the intermittent and $4604 (95% CI -$317, $24126) in the continuous group (incremental cost -$613 (95% CI -$20564, $7089). The mean effect measure, length of stay, was also similar between the two groups: 36.3 hours in the intermittent group and 40.2 hours in the continuous group. One-way sensitivity analyses on all variables revealed that the findings were robust and the incremental costs were not sensitive to the uncertainty within the defined ranges. Conclusion In a prospective economic evaluation conducted with a clinical trial, we found that intermittent monitoring was less expensive than continuous monitoring, considering societal and health care costs. These findings support recommendations to use intermittent pulse oximetry monitoring in hospitalized infants with stabilized bronchiolitis.

Abstract: Pulse oximetry is a noninvasive technology that is integral to the supportive care of hospitalized infants with bronchiolitis. A multicenter, randomized trial comparing the effectiveness of intermittent vs continuous pulse oximetry found similar length of hospital stay and safety outcomes, and greater nursing satisfaction, with intermittent monitoring. Objectives To evaluate the cost-effectiveness of intermittent vs continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis. Design, Setting, and Participants An economic evaluation concurrent with a randomized trial in community and tertiary children’s hospitals in Ontario, Canada, was conducted using a probabilistic analysis. Patients were enrolled from November 1, 2016, to May 31, 2019. Data included infants aged 4 weeks to 24 months hospitalized with bronchiolitis, with or without supplemental oxygen, after stabilization. The cost-effectiveness analysis adopted a societal and health care system perspective and a time horizon from hospitalization to 15 days post-discharge. Patient level direct health care costs and indirect costs were included. Health resource use, costs, and clinical outcomes were obtained from trial data. Publicly available pricing resources were used to supplement costs. Ranges for sensitivity analysis were based on 95% confidence intervals of the trial data. All costs were reported in 2021 Canadian dollars. Interventions Intermittent (every 4 hours) vs continuous pulse oximetry using an oxygen saturation target of 90% or higher. Main Outcomes and Measures Costs and incremental costs. Results Trial data from 229 infants (median [IQR] age, 4.0 [2.2-8.5] months; 136 boys [59.4%], 93 girls [40.6%] ) were included. Mean societal costs per patient were $6879 (95% CI, $3393 to $12 317) in the intermittent and $7428 (95% CI, $1743 to $25 011) in the continuous group with a mean incremental cost of −$548 (95% CI, −$18 486 to $8105). Mean health care system costs per patient were $4195 (95% CI, $1191 to $9461) in the intermittent and $4716 (95% CI, $335 to $22 093) in the continuous group (incremental cost, −$520; 95% CI, −$18 286 to $7358). The mean effect measure of length of stay was similar between the 2 groups: 37.4 hours (95% CI, 1.0 to 137.7 hours) in the intermittent group and 38.5 hours (95% CI, 0 to 237.1 hours) in the continuous group. One-way sensitivity analyses on all variables revealed that the findings were robust and the incremental costs were not sensitive to the uncertainty within the defined ranges. Conclusions and Relevance In this prospective economic evaluation study, we found that costs were similar for intermittent and continuous pulse oximetry considering societal and health care perspectives. Given that clinical outcomes between monitoring strategies are comparable and that other practice considerations favor intermittent monitoring, these findings provide additional information that support the use of intermittent monitoring in hospitalized infants with stabilized bronchiolitis.

Abstract: 〈 p 〉 〈 strong 〉 ABSTRACT 〈 /strong 〉 〈 /p 〉 〈 p 〉 〈 strong 〉 Background: 〈 /strong 〉 Expenditures on drugs dispensed and administered to patients in Canadian hospitals have been estimated at $2.4 billion per year. Pharmacy and therapeutics (P & amp;T) committees play a key role in the evaluation and management of drug therapies in this setting. Hospitals differ with respect to the composition of these committees, their members’ expertise, and the processes used for making formulary decisions. 〈 /p 〉 〈 p 〉 〈 strong 〉 Objectives: 〈 /strong 〉 To examine the current processes for formulary drug review from the perspective of P & amp;T committees and their individual members, and to examine the needs and preferences of these stakeholders related to evidence review and potential collaborative drug review processes within a large Local Health Integration Network (LHIN) in Ontario. 〈 /p 〉 〈 p 〉 〈 strong 〉 Methods: 〈 /strong 〉 Twenty-three sites within 10 hospital corporations in LHIN 4 (Hamilton Niagara Haldimand Brant) were recruited. A 2-part questionnaire was developed and pretested for clarity and comprehensiveness. The institution profile section of the questionnaire was to be completed by pharmacy directors and the P & amp;T section by committee members. 〈 /p 〉 〈 p 〉 〈 strong 〉 Results: 〈 /strong 〉 Ten pharmacy directors and 28 committee members representing 10 P & amp;T committees responded. A mean of 6.4 new drug requests were reviewed annually by each P & amp;T committee. Across the LHIN, the workload associated with reviewing submissions for new drugs to be added to the formulary represented 0.84 full-time equivalent. The quality of clinical evidence in the drug submissions was rated more favourably than the quality of economic evidence; furthermore, the use of economic evidence was limited by a lack of health economics expertise within the committees. A centralized review process for the LHIN was perceived as beneficial to improve efficiency, the quality of review, and standardization, and also to reduce costs. 〈 /p 〉 〈 p 〉 〈 strong 〉 Conclusions: 〈 /strong 〉 Across the Hamilton Niagara Haldimand Brant LHIN, considerable time and resources are spent on the review of potential new drugs for addition to the hospitals’ formularies. A standardized formulary review process, with greater use of provincial and national drug reviews, would likely benefit all LHINs. 〈 /p 〉 〈 p 〉 〈 strong 〉 RÉSUMÉ 〈 /strong 〉 〈 /p 〉 〈 p 〉 〈 strong 〉 Contexte : 〈 /strong 〉 Les dépenses pour les médicaments distribués et administers aux patients dans les hôpitaux canadiens ont été évaluées à 2,4 milliards de dollars par année. Les comités de pharmacologie et de thérapeutique jouent un rôle central dans l’analyse et la prise en charge des pharmacotherapies dans ce milieu. La composition de ces comités et l’expertise de leurs membres varient d’un hôpital à l’autre, tout comme les processus qui y sont employés pour prendre des décisions à propos de la liste des médicaments. 〈 /p 〉 〈 p 〉 〈 strong 〉 Objectifs : 〈 /strong 〉 Étudier les processus actuels d’ajout de médicaments à la liste locale du point de vue des comités de pharmacologie et de thérapeutique et de leurs membres. Examiner les besoins et préférences de ces parties prenantes quant à l’analyse des données probantes et aux potentiels processus collaboratifs d’évaluation des médicaments au sein d’un important réseau local d’intégration des services de santé (RLISS) ontarien. 〈 /p 〉 〈 p 〉 〈 strong 〉 Méthodes : 〈 /strong 〉 Vingt-trois établissements dans 10 organisations hospitalières du RLISS 4 (Hamilton Niagara Haldimand Brant) ont été retenus. On a élaboré un questionnaire de deux parties qui a été testé au préalable pour en vérifier la clarté et l’exhaustivité. La section sur le profil de l’établissement devait être remplie par les directeurs de pharmacie et celle sur la pharmacologie et la thérapeutique devait l’être par les membres des comités. 〈 /p 〉 〈 p 〉 〈 strong 〉 Résultats : 〈 /strong 〉 Dix directeurs de pharmacie et 28 membres représentant 10 comités de pharmacologie et de thérapeutique ont répondu. En moyenne, 6,4 nouvelles demandes d’ajout de médicament étaient analysées annuellement par chaque comité. Dans l’ensemble du RLISS, la charge de travail nécessaire à l’analyse des demandes d’ajout de nouveaux médicaments à la liste locale représentait 0,84 d’un poste équivalent temps plein. La qualité des données cliniques probantes dans les demandes d’ajout était considérée plus favorablement que celle des données économiques. De plus, comme les membres des comités ne possédaient pas l’expertise nécessaire en économie de la santé, l’utilisation des données probantes à ce sujet était limitée. Un processus centralisé d’analyse pour le RLISS était perçu comme avantageux pour améliorer l’efficience, la qualité de l’analyse et la normalization ainsi que pour réduire les coûts. 〈 /p 〉 〈 p 〉 〈 strong 〉 Conclusions : 〈 /strong 〉 Dans l’ensemble du RLISS de Hamilton Niagara Haldimand Brant, beaucoup de ressources et de temps sont accordés à évaluer l’ajout de médicaments à la liste locale. Tous les RLISS tireraient sûrement profit d’un processus normalisé d’ajout à la liste locale des médicaments ainsi que d’une meilleure utilisation des évaluations réalisées par les organismes provinciaux et national. 〈 /p 〉