An open randomized controlled trial of noninvasive positive pressure ventilation in patients of acute on chronic hypercapnic respiratory failure in a general respiratory ward setting

Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities

“…Estimates from both the Indian studies were very close regarding the total LOS of the NIV treatment group (9.4 vs 9.6 days), and the study that showed the smallest difference in LOS between the two groups (the Prasad study with a difference was 3.7 days compared to the Khilnani study with a difference of 8.4 days) was utilized to prevent any bias in the study against NIV treatment. [ 30 31 ] This was additionally supported by the older non-Indian study, which noted a difference in LOS of 3 days, and the large recent meta-analysis, which found that the difference in LOS for all the 11 studies included was 2.68 days. [ 13 36 ]…”

“…This cost analysis assumed that care would be provided in the ward, as several studies (including one India-based study) have suggested this is safe and effective. [ 8 30 ] Ward-based noninvasive ventilation is becoming more accepted in India, which makes this strategy more realistic. [ 8 30 ]…”

“…Prasad (2007, randomized, N = 19, LOS standard treatment = 13.33± 4.69 days and NIV treatment = 9.63± 1.41 days) and Khilnani (2010, randomized, N = 40, LOS standard treatment = 17.8± 2.6 days and NIV treatment, LOS = 9.4± 4.3 days) were both reviewed. [ 30 31 ] No data were provided on LOS for standard or NIV treatment groups in patients not needing rescue intubation, and both Indian studies had >50% intubation rate (which increases LOS). One older study (Brochard, 1995, randomized, N = 85, France based) noted total LOS for Standard treatment not needing intubation of 20 (±6) days and NIV treatment not requiring intubation of 17 (± 9) days (difference of 3 days).…”

“…As described earlier, only two Indian randomized trials of COPD getting NIV or standard treatment were found. [ 30 31 ] The number of days till death was assumed to be the number of days before mechanical ventilation. Although not specifically reported, both studies noted either rapid improvement with treatment (both standard and NIV treatment groups) or rapid decline so that by 24 h, the majority needing intubation had been intubated.…”

“…This assumption is supported by a study evaluating standard and non-invasive ventilation for COPD patients in India that found no difference at 4–6 weeks in blood gas parameters and pulmonary function variables. [ 30 ] It is also intuitive that once discharged alive, there is no difference between the two groups as there is no evidence showing that using NIV or not using NIV causes any long-term negative consequences. QALY estimates came from a study that measured QALY and survival years in 105 COPD respiratory failure patients treated only with NIV or standard therapy.…”