OBJECTIVES: A randomized clinical trial (HiFlo-Covid Trial) showed that in patients with severe COVID-19 treatment with high-flow oxygen therapy (HFOT) significantly reduced the need for invasive mechanical ventilation support and time to clinical recovery, compared with conventional oxygen therapy (COT). However, the cost of this strategy is unknown. Our objective was to analyze total length of stay (LOS) and 28-day cost of HFOT treatment compared with COT in a real-world setting.

METHODS: We conducted a post-trial-based cost analysis from the perspective of a managed competition healthcare system, using actual records of billed costs. Cost categories included were general ward LOS, intermediate care unit LOS, intensive care unit (ICU) LOS, imaging, laboratories, medication, physician’s honoraria, supplies, and others.

RESULTS: A total of 188 participants (mean age 60, 32.7% female) were included. Mean costs in the HFOT group (USD 751,231) were lower than in the COT group (USD $957,818). Overall, these differences did not attain statistical significance either for the total hospital stay (P=0.093) or for the 28-day period of the trial (P=0.121). However, resource use measured in dollars was always less costly for the HNFO group, with an overall percent decrease of 27%. Three categories make up 81% of all savings: Medications (41.3%), Intensive Care Unit (30.8%), and other procedures (8.5%).

CONCLUSIONS: This economic analysis suggests that among patients with severe COVID-19, cost of treatment with high-flow oxygen therapy (HFOT) is not significantly different when compared with conventional oxygen therapy (COT). This lack of statistical significance may be due to the wide variation (large standard deviation) of overall costs.