Cost–Utility Analysis of Home Mechanical Ventilation in Patients with Amyotrophic Lateral Sclerosis

Abstract

Amyotrophic lateral sclerosis is a disease with rapid progression. The use of mechanical ventilation helps to manage symptoms and delays death. Use in a home environment could reduce costs and increase quality of life. The aim of this study is a cost–utility analysis of home mechanical ventilation in adult patients with amyotrophic lateral sclerosis from the perspective of healthcare payers in the Czech Republic. The study evaluates home mechanical ventilation (HMV) and mechanical ventilation (MV) in a healthcare facility. A Markov model was compiled for evaluation in a timeframe of 10 years. Model parameters were obtained from the literature and opinions of experts from companies dealing with home care and home mechanical ventilation. The cost–utility analysis was carried out at the end of the study and results are presented in incremental cost–utility ratio (ICUR) using quality-adjusted life-years. Uncertainty was assessed by one-way sensitivity analysis and scenario analysis. The cumulative costs of HMV are CZK 1,877,076 and the cumulative costs of the MV are CZK 7,386,629. The cumulative utilities of HMV are 12.57 quality-adjusted life year (QALY) and the cumulative utilities of MV are 11.32 QALY. The ICUR value is CZK-4,403,259. The results of this study suggest that HMV is cost effective.

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

“…Table 1 reports a prevalence of NMDs using HMV at 2.9/100 000 inhabitants, which is in line with France in 2013 (3/100 000), 8 and Belgium Figure 1 Most recently estimated national prevalence of HMV in 24 countries. Prevalence by date of published reference: Austria, 5 Denmark, 5 Ireland, 5 Italy, 5 Portugal, 5 Spain, 5 France, 6 Germany, 6 UK, 6 Poland, 11 USA, 12 Australia, 13 New Zealand, 13 Canada, 14 South Korea, 15 Chile, 16 Greece, 17 Hungary, 18 Belgium, 19 Czech Republic, 9 Norway, 20 Sweden, 20 Finland, 20 Netherlands. 21 HMV, home mechanical ventilation.…”

“…NMD include amyotrophic lateral sclerosis, bilateral diaphragm paralysis, post-polio syndrome, spinal muscular atrophies, type 1 myotonic dystrophy, myopathies, muscular dystrophies, chronic polyradiculoneuritis and multiple sclerosis 8. Although the incidence of patients with NMD is stable, the prevalence rises slightly due to improved outcomes in this patient group 9 10. In France (2012), the number of people affected by NMD was estimated to be between 20 and 25 000 cases for 65.5 million inhabitants, corresponding to a prevalence of about 30/100 000 inhabitants 8…”

“…Figure 1 depicts the most recently reported prevalence from 24 national HMV programmes between 2005 and 2020 5 6 9 11–21. Available prevalence, ranging 1.2–47/100 000 inhabitants, was highly variable across countries.…”

“…Bilevel devices are cheaper (<4000€) than life-support ventilators (>6500€). Considering the bilevel lifespan over 7 years based on the authors’ experience, 1 year of treatment costs 630€, which includes accessory changes 1x/year 9. In Asia, inexpensive bilevel devices between 350€ and 600€ were developed to make HMV possible at low cost.…”

“…8 Although the incidence of patients with NMD is stable, the prevalence rises slightly due to improved outcomes in this patient group. 9 10 In France (2012), the number of people affected by NMD was estimated to be between 20 and 25 000 cases for 65.5 million inhabitants, corresponding to a prevalence of about 30/100 000 inhabitants. 8…”