Domiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD: an economic analysis

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) pose a significant burden to healthcare providers with frequent exacerbations necessitating hospital admission. Randomised controlled data exist supporting the use of acute non-invasive ventilation (NIV) in patients with exacerbations of COPD with mild to moderate acidosis. The use of NIV is also described in chronic stable COPD, with evidence suggesting a reduction in hospital admissions and general practitioner care. We present economic data on the impact of domiciliary NIV on the need for admission to hospital and its attendant costs. Methods: A cost and consequences analysis of domiciliary NIV based on a before and after case note audit was performed in patients with recurrent acidotic exacerbations of COPD who tolerated and responded well to NIV. The primary outcome measure was the total cost incurred per patient per year from the perspective of the acute hospital. Effectiveness outcomes were total days in hospital and in intensive care. Results: Thirteen patients were identified. Provision of a home NIV service resulted in a mean (95% CI) saving of £8254 (£4013 to £12 495) (J11 720; J5698 to J17 743) per patient per year. Total days in hospital fell from a mean (SD) of 78 (51) to 25 (25) (p = 0.004), number of admissions from 5 (3) to 2 (2) (p = 0.007), and ICU days fell from a total of 25 to 4 (p = 0.24). Outpatient visits fell from a mean of 5 (3) to 4 (2) (p = 0.14).Conclusions: This study suggests that domiciliary NIV for a highly selected group of COPD patients with recurrent admissions requiring NIV is effective at reducing admissions and minimises costs from the perspective of the acute hospital. Such evidence is important in obtaining financial support for providing such a service.

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

“…In the UK, domiciliary NIV is considered on health economic grounds if a patient has had three hospital admissions with acute HRF, 40 although, given the absence of a full economic evaluation, such use could be considered not fully evidence based. Given this, an economic evaluation of domiciliary NIV in stable end-stage COPD is warranted.…”

Effects of Provided Trainings Regarding Non-Invasive Mechanical Ventilation on the Knowledge Level of Nurses

“…The information form, which was prepared on the basis of literature information, consisted of 20 questions (7,(11)(12)(13)(14)(15)(16)(17)(18). More than one of the options provided in questions 1, 2, 3, 4, 5, 6, 9, 10, and 20 were correct; the participants were expected to mark all correct items.…”

“…Training-related documents were prepared to be provided to the participants before and after training (7,11,13,14,(16)(17)(18).…”

Noninvasive Positive-Pressure Ventilation Therapy in Patients with COPD

“…The reported studies show some physiological benefits for the use of NPPV in stable COPD, but clear survival benefit has not yet been demonstrated (Leger et al 1994;Jones et al 1998;Tuggey, Plant, & Elliott 2003). All of these and most other studies used a moderately aggressive ventilation to treat stable hypercapnic COPD patients and so an impressive reduction in hypercapnia was not achieved.…”