Adaptation and follow-up to noninvasive home mechanical ventilation: Ambulatory versus hospital

Doménech-Clar, Rosalía; Nauffal-Manssur, Dolores; Compte-Torrero, Luís; Rosales-Almazán, Ma Dolores; Martínez-Pérez, Encarna; Soriano-Melchor, Elisa

doi:10.1016/j.rmed.2008.07.018

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…Despite this, consensus on how best to implement NIV for treatment-naive users is lacking [1,5,6]. A variety of implementation methods have been reported, ranging from inpatient hospital assessments to ambulatory or home-based models [1,[7][8][9][10][11]. Reports have also described varying combinations of clinical assessments and other measures that may assist with treatment initiation and monitoring.…”

Section: Introductionmentioning

confidence: 99%

Randomised controlled trial of polysomnographic titration of noninvasive ventilation

et al. 2019

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Noninvasive ventilation (NIV) settings determined during wakefulness may produce patient–ventilator asynchrony (PVA) during sleep, causing sleep disruption and limiting tolerance. This study investigated whether NIV titrated with polysomnography (PSG) is associated with less PVA and sleep disruption than therapy titrated during daytime alone.Treatment-naive individuals referred for NIV were randomised to control (daytime titration followed by sham polysomnographic titration) or PSG (daytime titration followed by polysomnographic titration) groups. Primary outcomes were PVA and arousal indices on PSG at 10 weeks. Secondary outcomes included adherence, gas exchange, symptoms and health-related quality of life (HRQoL).In total, 60 participants were randomised. Most (88.3%) had a neuromuscular disorder and respiratory muscle weakness but minor derangements in daytime arterial blood gases. PVA events were less frequent in those undergoing polysomnographic titration (median (interquartile range (IQR)): PSG 25.7 (12–68) events·h−1versus control 41.0 (28–182) events·h−1; p=0.046), but arousals were not significantly different (median (IQR): PSG 11.4 (9–19) arousals·h−1versus control 14.6 (11–19) arousals·h−1; p=0.258). Overall adherence was not different except in those with poor early adherence (<4 h·day−1) who increased their use after polysomnographic titration (mean difference: PSG 95 (95% CI 29–161) min·day−1versus control −23 (95% CI −86–39) min·day−1; p=0.01). Arterial carbon dioxide tension, somnolence and sleep quality improved in both groups. There were no differences in nocturnal gas exchange or overall measures of HRQoL.NIV titrated with PSG is associated with less PVA but not less sleep disruption when compared with therapy titrated during daytime alone.

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Section: Introductionmentioning

confidence: 99%

Randomised controlled trial of polysomnographic titration of noninvasive ventilation

et al. 2019

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“…As proved by foreign studies [6,[34][35][36][37][38][39][40][41][42], HMV is associated with the benefits of longer survival and improved quality of life. Assessing health-related quality of life is becoming an increasingly important criterion in research and healthcare, especially in the evaluation of the cost-benefit ratio of medical devices or patients with chronic, incurable disorders [37,41].…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, a cost-utility analysis examining its benefits in terms of quality of life was selected to evaluate HMV and MV variants in patients with ALS. On the basis of the mentioned studies [6,[34][35][36][37][38][39][40][41][42] and the opinion of experts, the assumption of a 10% reduction in the quality of life of a patient in a hospital environment was chosen for the cost-utility analysis. The value of the reduction was subsequently varied in the sensitivity analysis and changed the significance of ICUR as the only input, and HMV as the only dominant variant became cost-effective, if we assume that both variants fall below the willingness to pay threshold as they are already covered.…”

Section: Discussionmentioning

confidence: 99%

“…The health state "IV", being "HMV" in the Markov tree, was thus assigned with the same values as the health condition "NIV". Based on the conclusions of foreign studies [6,[34][35][36][37][38][39][40][41][42] proving improvements in the quality of life of patients in home environments, and based on consultations with experts, the utility value for the health states "MV" in the Markov tree and the health state "Hospitalization" decreased by 10%. As with the costs, a 3% rate was selected to discount the benefits [25,30].…”

Section: Utility Identificationmentioning

confidence: 99%

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

et al. 2021

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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.

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“…However, hospitalization is expensive, there may be waiting lists, and it has not been conclusively demonstrated that this policy leads to better compliance with the prescription [11,12]. Thus, some authors prefer to carry out NIMV adaptation in the sleep laboratory [13,14], whereas others advocate ambulatory adaptation in an outpatient clinic or the patient's home [11,12,15].…”

Section: Introductionmentioning

confidence: 99%

Ambulatory adaptation to noninvasive ventilation in restrictive pulmonary disease: A randomized trial with cost assessment

Pallero

Puy

Güell

et al. 2014

Respiratory Medicine

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Adaptation and follow-up to noninvasive home mechanical ventilation: Ambulatory versus hospital

Abstract: HMV improved arterial blood gases and quality of life in patients with restrictive ventilatory disorders. Arterial blood gases were better in the ambulatory group and the quality of life was similar in both groups.

Cited by 17 publications

References 23 publications

Randomised controlled trial of polysomnographic titration of noninvasive ventilation

Randomised controlled trial of polysomnographic titration of noninvasive ventilation

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

Ambulatory adaptation to noninvasive ventilation in restrictive pulmonary disease: A randomized trial with cost assessment

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