Nov 172018
 

by Ed Susman, Contributing Writer, MedPage Today

SAN DIEGO -- Noninvasive ventilation aimed for use at home by late-stage patients with chronic obstructive pulmonary disease (COPD) actually saves patients and the healthcare system money by helping to keep individuals out of the hospital and doctors' offices, researchers said here. Nightly home noninvasive ventilation (commonly called BiPAP) was previously shown to reduce COPD exacerbations near the end of life.

In a cost-effectiveness study, patients who used the new home noninvasive ventilation devices -- which have a price tag of around $3,000 -- in addition to home oxygen therapy actually saved the healthcare system $3,927 per person compared with the costs associated with oxygen therapy alone, said Nicholas Hart, MB, PhD, of Lane Fox Respiratory Service of Guy's & St Thomas' Trust Hospital in London, and colleagues.

The total costs were $24,458 for home oxygen therapy plus home noninvasive ventilation versus $28,386 for home oxygen therapy alone, Hart reported at the American Thoracic Society (ATS) annual meeting.

Noninvasive ventilation was delivered using the Harmony 2 ventilator (Philips Respironics) or the VPAP IIISTa ventilator (ResMed).

Remarkably, the quality-adjusted life years gained with the two systems was a negative $50,856 -- suggesting that when very ill COPD patients use both devices, their costs are lowered and their quality of live is improved, he said.

The researchers said that among the patients using the ventilation system, costs were $4,298 for devices, $10,805 for doctor visits, $758 for medication, and $8,598 for treatment of exacerbations, while the corresponding costs for oxygen therapy alone were $1,582 for devices, $15,033 for doctor visits, $1,088 for medication, and $10,683 for treatment of exacerbations.

"Patients who suffer from COPD and face frequent hospitalization due to their disease previously had limited treatment and care options available to them," said Hart. "We're all searching for healthcare solutions that improve patient outcomes but are also economically feasible – and scalable. For that reason, it's exciting to see data showing we can achieve both of these through a combination of therapies."

The data were culled from an economic analysis of a Philips-sponsored, randomized clinical trial of 116 patients in the U.K. carried out by respiratory experts at Guy's & St Thomas'. Results of that 5-year, multicenter study were announced at ATS 2017 and published in the Journal of American Medical Association, but the potential health economic impact was not known then.

In the new study, Hart said doctors observed that patients just on oxygen therapy returned to the hospital for exacerbation of COPD after about 1.4 months. But the time to re-admission for COPD exacerbation was 4.3 months for patients on oxygen therapy and home noninvasive ventilation -- a difference of 90 days. He noted that in the United States and other countries hospitals and facilities are financially penalized if patients have to return to the facility within 28 days after discharge. Using the dual therapies, fewer patients would fall into that time frame, Hart said.

Asked for her opinion, Linda Nici, MD, of Providence Veterans Administration Medical Center in Rhode Island, who was not involved with the study, said: "The increased time to readmission due to exacerbation is a big deal. Time to exacerbation is the hot thing right now. Your driver of costs in this population is all in the exacerbation and frequent re-exacerbations. The 2-week post-exacerbation period is a very vulnerable time for these patients because they tend to re-exacerbate in that short window, so [the device] is something you might send someone home with as they convalesce to try to get them up to a better level of physical activity and quality of life and maybe it would prevent that second readmission.

"We do use noninvasive ventilation at the VA because we have a lot of severe COPD patients," Nici noted. "With this device, I see that patients have better well-being -- they have better quality of life during the day. We sometimes utilize it even in the pulmonary rehabilitation setting to allow their patients to exercise longer. Noninvasive ventilation is exceeding helpful in more advanced COPD patients."

Hart disclosed relevant relationships with Phillips, Resmed, Fisher-Paykel, B&D Electromedical, AstraZeneca, and GlaxoSmithKline.

Nici reported having no relevant relationships with industry.

Source: Society meeting abstract

--From MedPage Today

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Home non-invasive ventilation reduced health costs in severe COPD