Home Mechanical Ventilation Use in South Korea Based on National Health Insurance Service Data

Abstract

BACKGROUND:In Asian countries, nationwide data on patients undergoing home mechanical ventilation are limited. METHODS: This study investigated the prevalence and primary indications for home mechanical ventilation use in South Korea by using nationwide registry data from the National Health Insurance Service. RESULTS: The study period included a total of 4,785 subjects on home mechanical ventilation (mean ؎ SD age, 56.0 ؎ 23.9 y; females, 40.1%). The estimated overall prevalence of home mechanical ventilation use in South Korea was 9.3 per 100,000, with a prevalence of 6.3 per 100,000 among children (ages < 15 y). The most common primary diagnoses were neuromuscular diseases (42.0%) and lung and/or airway diseases (27.7%). The prevalence of lung and/or airway and cerebrovascular diseases as the primary diagnosis increased with age (r ‫؍‬ 0.310, P < .001; and r ‫؍‬ 0.156, P < .001, respectively). Noninvasive ventilation was used by 37.2% of all the subjects, with the highest prevalence in those with neuromuscular diseases (54.4%) or chest wall diseases (53.4%). Noninvasive ventilation use was lowest among subjects with brain lesions. Home mechanical ventilation was most commonly prescribed by internists (41.3% of cases), followed by rehabilitation and neurology physicians. CONCLUSIONS: These data will aid in planning the optimal health-care system for users of home mechanical ventilation locally and will allow for comparison of home mechanical ventilation use rates among countries.

Challenges to and opportunities for the implementation of non‐invasive positive pressure ventilation in the Asia‐Pacific region

“…The use of NPPV in this region has increased considerably from simple case studies to multicentre randomized controlled trials (RCT), and from clinical use to scientific investigation . Academia has gradually recognized the clinical importance of NPPV.…”

“…In the Asia‐Pacific region, prevalence of home ventilation in New Zealand was reported to be 12/100 000 while in Hong Kong, China, it was only 2.9/100 000. Many other countries have been unable to provide prevalence data . Bilevel ventilation was the main method for home NPPV, accounting for 94.8% in Hong Kong, 96.9% in Australia and New Zealand and 89% in Europe .…”

“…Bilevel ventilation was the main method for home NPPV, accounting for 94.8% in Hong Kong, 96.9% in Australia and New Zealand and 89% in Europe . In contrast, 37.2% of patients in Korea reported using NPPV as their form of home ventilation . In mainland China, the social medical security system does not cover the cost of purchase and maintenance of home NPPV ventilators.…”

“…Setting up home therapy also requires consideration of machine and accessory maintenance. This often requires the cooperation of medical staff with manufacturers and third‐party players who may be responsible for ongoing home care services and regular checking of equipment …”

“…The use of NPPV in this region has increased considerably from simple case studies to multicentre randomized controlled trials (RCT), and from clinical use to scientific investigation. [6][7][8][9][10][11][12][13] Academia has gradually recognized the clinical importance of NPPV. However, compared with the developed countries, the use of NPPV clinically in the Asia-Pacific region continues to lag behind than seen in many Western countries.…”