Building a home ventilation programme: population, equipment, delivery and cost

Abstract

Home mechanical ventilation (HMV) improves quality of life and survival in patients with neuromuscular disorders (NMD). Developing countries may benefit from published evidence regarding the prevalence, cost of equipment, technical issues and organisation of HMV in NMD, facilitating the development of local turn-key HMV programmes. Unfortunately, such evidence is scattered in the existing literature. We searched Medline for publications in English and French from 2005 to 2020. This narrative review analyses 24 international programmes of HMV. The estimated prevalence (min–max) of HMV is ±7.3/100 000 population (1.2–47), all disorders combined. The prevalence of HMV is associated with the gross domestic product per capita in these 24 countries. The prevalence of NMD is about 30/100 000 population, of which ±10% would use HMV. Nocturnal (8/24 hour), discontinuous (8–16/24 hours) and continuous (>16/24 hours) ventilation is likely to concern about 60%, 20% and 20% of NMD patients using HMV. A minimal budget of about 168€/patient/year (504€/100 000 population), including the cost of equipment solely, should address the cost of HMV equipment in low-income countries. When services and maintenance are included, the budget can drastically increase up to between 3232 and 5760€/patient/year. Emerging programmes of HMV in developing countries reveal the positive impact of international cooperation. Today, at least 12 new middle, and low-income countries are developing HMV programmes. This review with updated data on prevalence, technical issues, cost of equipment and services for HMV should trigger objective dialogues between the stakeholders (patient associations, healthcare professionals and politicians); potentially leading to the production of workable strategies for the development of HMV in patients with NMD living in developing countries.

Long-term mechanical ventilation and transitions in care: A narrative review

“… 2 , 19 However, community-based LTMV programs vary widely, from well-supported to piecemeal or non-existent. 3 , 25 , 33 , 36 , 43 , 46 , 49 Variations usually are due to differences in jurisdiction and legislation, occurring at the national, state/provincial level, and/or regional/municipal level. 31 , 33 …”

“…Individuals dependent on long-term mechanical ventilation (LTMV) for their day-to-day living are a heterogenous population whose prevalence has steadily been rising secondary to technological and clinical care advances. [1][2][3] With this associated increase in survival, the ventilatorassisted individual (VAI) may experience several crucial healthcare transitions during their lifetime. Rose et al 4 defined seven key transitions in a 2014 Delphi study: 1) acute care to prolonged mechanical ventilation (PMV)/ LTMV, 2) PMV to LTMV, 3) PMV/LTMV to acute care 4) no ventilation to PMV/LTMV, 5) institution/hospital to community/home, 6) pediatric to adult PMV/LTMV, and 7) active treatment to end-of-life (EOL).…”

Ventilator Weaning in Prolonged Mechanical Ventilation—A Narrative Review

“…The 1-year survival rate in this population is approximately 30% [87]. Home ventilation has been an emerging alternative for these patients, but the standards of home ventilator care have not been established [88]. Recently, Jacobs et al argued that home ventilation programs can be as successful as ventilator care in the LTACH [89].…”

Development and pilot-testing of an evidence-based quality indicator set for home mechanical ventilation care: the OVER-BEAS project

“…The costs for the 1:1 care of an HMV patient at home can be up to 250.000 Euros per year [ 1 ], while the expenditure generated by out-of-hospital intensive care services is estimated at over 2.2 billion euros per year in Germany [ 19 ]. Although proven to be beneficial and cost-effective in several indications and settings [ 20 ], HMV poses a major challenge to the health system, both in respect to personnel and financial resources, as the growing need for HMV might result in a decline of quality of care and unfavourable outcomes.…”