An Evaluation Of Health Technology For Home-Based Heated Humidified High-Flow Therapy For Respiratory Disorders

Abstract

This health technology assesses the safety and efficacy of home-based heated humidified high-flow therapy (HHHFT) for children with obstructive sleep apnea who are unable to tolerate traditional respiratory therapies at home, as well as for individuals with respiratory conditions who lack alternative treatment options to provide equivalent respiratory support at home. Additionally, it assesses the experiences, preferences, and values of individuals with respiratory diseases as well as the financial implications of publicly funded home-based HHHFT.  Methods: We conducted a thorough search of the literature to find clinical evidence supporting the safety and efficacy of home-based HHHFT for the categories. Due to a lack of evidence, we did not perform a main economic review despite conducting a systematic search of the economic literature. In Ontario, we examined the financial effects of publicly funded home-based HHHFT for children with pediatric OSA as well as for adults and children with various respiratory disorders. We sought to interview individuals and caregivers of children in Ontario who had firsthand experience with respiratory disorders, both with and without direct HHHFT, in order to contextualize the possible benefits of home-based HHHFT. Conclusions: We found several studies carried out in different settings that showed the advantages of HHHFT, such as better oxygenation, lower respiratory rates, less severe OSA, and fewer acute exacerbations of chronic obstructive pulmonary disease when used in hospitals and at home. However, we did not find any studies that specifically assessed the comparative efficacy and safety of home-based HHHFT in relation to our research questions. Additionally, HHHFT is standard care in Ontario hospitals, where it is widely utilized and largely regarded as clinically beneficial. Over the next five years, we project that publicly funded home-based HHHFT in Ontario would save children with pediatric OSA and add $2.5 million to the expenses of treating adults and children with other chronic respiratory illnesses. We calculate that fewer hospital visits, fewer outpatient visits, and fewer inpatient days would be avoided if home-based HHHFT were publicly funded. Home-based HHHFT was seen favorably by caregivers of children with respiratory disorders; for many, it became a necessary treatment after all other choices failed. Cost was a significant obstacle to receiving this treatment, though.