Cost-Effectiveness of Domiciliary High Flow Nasal Cannula Treatment in COPD Patients with Chronic Respiratory Failure

Abstract

Purpose To evaluate the cost-effectiveness of long-term domiciliary high flow nasal cannula (HFNC) treatment in COPD patients with chronic respiratory failure. Patients and Methods A cohort of 200 COPD patients were equally randomized into usual care ± HFNC and followed for 12 months. The outcome of the analysis was the incremental cost per quality-adjusted life-year (QALY) gained, and the analysis was conducted from a healthcare sector perspective. Data on the patients’ health-related quality of life (HRQoL), gathered throughout the trial using the St. George’s Respiratory Questionnaire (SGRQ), was converted into EQ-5D-3L health state utility values. Costs were estimated using Danish registers and valued in British pounds (£) at price level 2019. Scenario analyses and probabilistic sensitivity analyses were conducted to assess the uncertainty of the results. Results The adjusted mean difference in QALYs between the HFNC group and the control group was 0.059 (95% CI: 0.017; 0.101), and the adjusted mean difference in total costs was £212 (95% CI: −1572; 1995). The analysis resulted in an incremental cost-effectiveness ratio (ICER) of £3605 per QALY gained. At threshold values of £20.000–30.000 per QALY gained, the intervention had an 83–92% probability of being cost-effective. The scenario analyses all revealed ICERs below the set threshold value and demonstrated the robustness of the main result. Conclusion This is the first cost-effectiveness study on domiciliary HFNC in Europe. The findings demonstrate that long-term domiciliary HFNC treatment is very likely to be a cost-effective addition to usual care for COPD patients with chronic respiratory failure. The results must be interpreted in light of the uncertainty associated with the indirect estimation of health state utilities.

Hospital Cost Savings for Sequential COPD Patients Receiving Domiciliary Nasal High Flow Therapy

“…The methods of the Danish clinical trial and the characteristics of the patients have been reported in detail. 14 , 15 Briefly, 200 patients were randomized into usual care ± NHF. At inclusion, acute exacerbations of COPD and hospital admissions one year before inclusion, modified Medical Research Council (mMRC) score, St George’s Respiratory Questionnaire (SGRQ), forced expiratory volume in 1 second (FEV1), 6-minute walk test (6MWT) and arterial carbon dioxide (PaCO 2 ) were recorded.…”

“…Published analysis of the clinical study showed a substantial reduction in exacerbations, as counted via patient diaries and phone calls. 14 , 15 However, the available information does not clarify how non-admitted patients were managed, and detailed information about the timing of these exacerbations is not available. Therefore, in order to avoid double counting and the need to impute missing data, we excluded all patient-reported information from the current analysis.…”

“… 3 , 6–10 The clinical and economic benefits of NHF for both COPD and bronchiectasis patients in the ambulatory care setting have also been evaluated in randomized controlled trials both in NZ 11–13 and in Denmark. 14 , 15 Subsequent economic evaluation in NZ showed this intervention to be cost effective by local criteria, with a cost per quality adjusted life year (QALY) of around $NZ20,000. 11 …”

“…Exclusion criteria were malignant disease, terminal nonmalignant disease, unstable psychiatric disease, and long-term non-invasive ventilation. 14 …”

“…Subsequent economic analysis of the same study reported a substantial increase in quality of life based on the St George’s Respiratory Questionnaire and when mapped to quality adjusted life years (QALYs). 14 …”