[AVBC 2025] Cost-Efficiency of High-flow Oxygen Therapy in High Dependency Units: A Value-based Care Approach
Care Process & Redesign
Appropriate & Value-based Care Conference
SingHealth
21 November 2025
To evaluate the cost-effectiveness and safety of initiating high-flow oxygen therapy in the High-dependency unit to reduce. The findings support the expansion of HFOT services in HDU settings, optimizing healthcare resource utilization without compromising.
Year Submitted: 2025
Published Date: 21 November 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Cost Effectiveness, Cost Saving, Value Based Care, Safe Care, Access To Care, Bed Occupancy Rate
About this Content
Aims
To evaluate the cost-effectiveness and safety of initiating high-flow oxygen therapy in the High-dependency unit to reduce avoidable ICU admissions.
Background
High-flow oxygen therapy (HFOT) is a treatment modality for critically ill patients with respiratory failure. Such patients are typically cared for in intensive care units (ICU), incurring a high treatment cost. This study assesses the feasibility and safety of implementing HFOT in high dependency units (HDU) as a value-based care initiative in a Singaporean restructured hospital.
Methods
A prospective quality improvement initiative was carried out in the HDU from February 2019 to June 2025. Adult patients admitted under the surgical division requiring HFOT were included. The primary outcomes measured were successful HFOT management in HDU without ICU transfer and cost savings from avoiding ICU admission. The cost analysis assumes a patient with A1 private class status which covers only daily room charges and basic treatment fees.
Results
The implementation of HFOT in the HDU demonstrates a safe and cost-effective approach to respiratory support, with potential savings of at least SGD $401.28 per avoided ICU admission per day. With 132 successful cases of an average duration HFOT treatment day of 2.5 days/patient, the total cost savings amounted to SGD $132,422.40. Patient safety was maintained with no adverse events reported.
Conclusion
The findings support the expansion of HFOT services in HDU settings, optimizing healthcare resource utilization without compromising patient outcomes.
Lessons Learnt
These results demonstrated the feasibility of HDU-based HFOT and support a step care approach. The most common indication for HFOT was primarily hypoxemic respiratory failure.
Keywords
High-flow oxygen therapy, ICU, HDU, cost savings, respiratory support
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | SingHealth |
Organization(s) Involved | Singapore General Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Intensive Care Medicine, Respiratory Therapy |
Project Lead(s) | Ho Vui Kian |
Project Member(s) | Chong Hui Ling Joanne |
Connect with this contributor!
Chong Hui Ling Joanne - joanne.chong.hui.ling@sgh.com.sg