Healthcare utilisation and costs of home mechanical ventilation

Nonoyama, Mika; McKim, Douglas; Road, Jeremy; Guerriere, Denise N.; Coyte, Peter C.; Wasilewski, Marina B; Avendaño, Mónica; Katz, Sherri; Amin, Reshma; Goldstein, Roger; Zagorski, Brandon; Rose, Louise

doi:10.1136/thoraxjnl-2017-211138

Cited by 32 publications

(32 citation statements)

References 27 publications

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“…TPPV creates a major burden for caregivers in Switzerland because options for long-term care of ventilator-dependent tracheotomized patients outside the hospital are limited and financial support for qualified help at home is often insufficient. Healthcare costs for patients with chronic respiratory failure are far higher for invasive than for non-invasive ventilation [220]. Management of patients on invasive ventilation usually requires 24-h care.…”

Section: Special Situationsmentioning

confidence: 99%

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

et al. 2020

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Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.

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Section: Special Situationsmentioning

confidence: 99%

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

et al. 2020

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“…Few studies examine the cost of home mechanical ventilation. In a recent Canadian study, however, the overall median monthly healthcare cost with invasive ventilation was €6,200 across all diagnoses with the highest cost in ALS (range: €6,031-12,471) [35]. In a Norwegian, context the presence of professional carers in the patient's home around the clock would incur yearly costs in excess of €500,000, which would be covered by public funds.…”

Section: Justicementioning

confidence: 97%

Ethical challenges in tracheostomy-assisted ventilation in amyotrophic lateral sclerosis

et al. 2018

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The special nature of amyotrophic lateral sclerosis (ALS) and tracheostomy with invasive ventilation (TIV) leads to challenges that can be difficult in two senses: not only to handle well, but also to discuss with patients and other involved stakeholders. Because of the delicate nature of interpersonal relations and communication in ALS, some of the downsides to TIV may almost take on a nature of taboo, making them difficult to raise for open discussion. Yet these ethical challenges are important to be aware of, not only for health professionals and managers but, arguably, also for patients and next of kin. They are important also for a wider professional and societal debate about whether and to whom TIV should be offered. In this paper we highlight and examine ethical challenges in TIV for ALS, with a special emphasis on those that are hard to discuss openly and that therefore might fail to be addressed. The analysis is structured by the four core principles of healthcare ethics: beneficence, nonmaleficence, respect for patient autonomy, and justice.

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“…Limited data are available on health care costs for HMV patients; higher costs are associated with more severe disease [97] and with the use of HMV in patients with ALS [33]. Indeed, a recent Canadian study found that 39% of the monthly health care costs was due to caregiving time provided by family members [98]. In this regard, home care programs meeting patient’s specific needs would be desirable to avoid the cost of respiratory assistance and of chronic care.…”

Section: Home Care Management Of Long-term Noninvasive Ventilationmentioning

confidence: 99%

Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas

Crimi

Pierucci²,

Carlucci

et al. 2019

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Background: Noninvasive mechanical ventilation (NIV) is an effective treatment in patients with neuromuscular diseases (NMD) to improve symptoms, quality of life, and survival. Summary: NIV should be used early in the course of respiratory muscle involvement in NMD patients and its requirements may increase over time. Therefore, training on technical equipment at home and advice on problem solving are warranted. Remote monitoring of ventilator parameters using built-in ventilator software is recommended. Telemedicine may be helpful in reducing hospital admissions. Anticipatory planning and palliative care should be carried out to lessen the burden of care, to maintain or withdraw from NIV, and to guarantee the most respectful management in the last days of NMD patients’ life. Key Message: Long-term NIV is effective but challenging in NMD patients. Efforts should be made by health care providers in arranging a planned transition to home and end-of-life discussions for ventilator-assisted individuals and their families.

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Healthcare utilisation and costs of home mechanical ventilation

Cited by 32 publications

References 27 publications

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

Ethical challenges in tracheostomy-assisted ventilation in amyotrophic lateral sclerosis

Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas

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