Pairing oxygen with noninvasive ventilation at home for patients with chronic obstructive pulmonary disease (COPD) with persistent high carbon dioxide levels in the blood, who had recently had a life-threatening exacerbation requiring hospitalization, was cost effective, according to results of an abstract presented at a recent medical conference.
Pairing oxygen with noninvasive ventilation (NIV) at home for patients with chronic obstructive pulmonary disease with persistent high carbon dioxide levels in the blood, who had recently had a life-threatening exacerbation requiring hospitalization, was cost effective, according to results of an abstract presented at a recent medical conference.
In an earlier study, home oxygen therapy (HOT) combined with home noninvasive ventilation (HMV) was found to be more effective than HOT alone. The latest study looked at the cost effectiveness of the treatment and found that HOT-HMV is also less expensive.
The study, sponsored by health technology firm Royal Philips, which makes respiratory equipment, found that comparing the accumulated cost of devices, doctor visits, medication, and hospitalizations produced an average annual cost savings of $3927 per patient. The results were presented at the American Thoracic Society 2018 International Conference in San Diego, California.
Patients in the control arm were permitted to have HMV added to HOT if they had to be readmitted to the hospital and if they had persistent acidosis and an inability to wean from NIV. In the 12-month study, 28 out of 59 HOT patients and 36 out of 57 HOT-HMV patients completed the trial and 17 patients allocated to HOT received additional HMV. Hospital readmission within 30 days was 58.3% lower in the intervention group.
Costs were calculated by multiplying observed medical resource utilization by standard unit costs. The analysis indicated that the incremental cost per quality-adjusted life years (QALY) was —$50,856, suggesting that using HOT-HMV was both less expensive and more effective.
Total costs were $24,458 for HOT-HMV and $28,386 for HOT alone. For HOT-HMV, costs were $4298 for devices, $10,805 for doctor visits, $758 for medication, and $8598 for exacerbations. For HOT alone, costs were $1582, $15,033, $1088, and $10,683.
One-way sensitivity analysis suggests cost per physician visit has the greatest impact on cost/QALY. The bootstrap analysis indicates the probability for HOT-HMV to both save costs and improve quality of life is 75.7%.
Criner GJ, GU Q, Murphy PB, et al. Cost-effectiveness of home oxygen therapy-home mechanical ventilation (HOT-HMV) for treatment of chronic obstructive pulmonary disease (COPD) with chronic hypercapnic respiratory failure following an acute exacerbation of COPD in the United States. Presented at the American Thoracic Society 2018 International Conference; May 18-23, 2018; San Diego, California. Abstract A2518.