Delivery of heliox with a semi-closed circuit during spontaneous breathing: a comparative economic theoretical study

Abstract

BackgroundHeliox is a mixture of oxygen and helium which reduces airway resistance in patients with airway obstruction. In clinical practice, patients breathing spontaneously receive heliox via an open circuit. Recently, a semi-closed circuit for heliox administration has been proposed which minimizes consumption of heliox and therefore cost of the heliox therapy; although, the semi-closed circuit is associated with additional costs. The aim of the study is to conduct an economical analysis comparing total cost of heliox therapy using an open versus a semi-closed circuit in spontaneously breathing patients with airway obstruction.MethodsFour different systems for heliox administration were analyzed: an open circuit and three alternatives of a semi-closed circuit involving a custom made semi-closed circuit and two standard anesthesia machines. Total costs of heliox therapy were calculated for all the systems. For calculation of gas consumption, the clinical procedures limiting continuous heliox therapy including the aerosol therapy, personal hygiene and nutrition were taken into account. A sensitivity analysis was conducted for main input variables that may influence the results of the study.ResultsPrice of gases consumed by a semi-closed system represents less than 20 % of price of gases when a standard open circuit is used. This represents a saving of approximately 540 EUR per patient. The initial cost of the custom-made semi-closed circuit recuperates after treatment of 18 patients. The corresponding number of patients is 32 when a low-cost anesthesia machine is initially acquired and rises to 69 when a highly advanced anesthesia machine is considered.ConclusionsHeliox therapy in spontaneously breathing patients using a semi-closed circuit becomes more cost-effective compared to the open circuit, currently used in clinical practice, when applied in a sufficient number of cases. The impact of finding a cheaper way of heliox administration on the clinical practice needs to be ascertained.

Neonatal Applications of Heliox: A Practical Review

“…Heliox price in the UK in 2022 for the “HX” cylinder (1,780 L) is 413 GBP while the same cylinder of medical oxygen (2,300 L) is 17 GBP and medical air G cylinder (3200 L) is 14 GBP pounds ( 55 ). A Czech study reported the price of a 50 L cylinder at 200 bar to be 233 EUR vs. 46 EUR for oxygen (also 50 L at 200 bar) ( 56 ). As significant differences in Heliox consumption were shown between different ventilators the choice of the device may influence the cost of the therapy ( 48 ).…”

“…Further savings might be achieved with a semi-closed circuit. Jurickova I et al described a custom-made delivery system that allowed substantial reduction of costs when compared to an open circuit ( 56 ).…”

Anesthetic Management for Concomitant Correction of Congenital Cardiac Defects and Long “O” Ring Tracheal Stenosis: A Role for Heliox?: Report of 2 Cases

“…This configuration also allowed control of the tidal volume by direct hand ventilation and chest expansion observation. Although semiclosed circuits for helium administration would be much more cost-effective according to Jurickova et al, 14 the relative short-term use and the risk of volume-induced injury made us favor our custom-made open circuit. Furthermore, not every ventilator is Food and Drug Administration approved for delivery of heliox.…”

Administration of inhaled noble and other gases after cardiopulmonary resuscitation: A systematic review

“…[51] It is considered relatively cheap (only 5 times the price of oxygen). [52] The mixture of He and oxygen (Heliox) is FDA approved for human administration provided the medical grade of the gas administered is upheld [53], and has been shown to be safe for humans. [54] It has a low density that facilitates transition of small airway gas flow from turbulent to laminar.…”