Cost-effectiveness of home non-invasive ventilation in patients with persistent hypercapnia after an acute exacerbation of COPD in the UK

Murphy, Patrick B.; Brüeggenjuergen, B; Reinhold, Thomas; Gu, Qing; Fusfeld, Laura; Criner, Gerard J.; Goss, Thomas F.; Hart, Nicholas

doi:10.1136/thorax-2022-219653

Cited by 6 publications

(1 citation statement)

References 12 publications

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“…The cost per quality-adjusted life-year was £10,259, which is below the UK cost-effectiveness threshold and compares favourably with other common interventions used in COPD. 25 Over the period covered by the current study, we were able to deliver a significant increase in NIV provision in Glasgow without any additional staffing. This is consistent with preliminary data from our centre showing no increase in nurse specialist team workload for remote NIV initiation.…”

Section: Discussionmentioning

confidence: 82%

Impact of remote-monitored home non-invasive ventilation on patient outcomes: a retrospective cohort study

Levey,

Manthe,

Taylor

et al. 2024

Preprint

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Introduction Use of home non invasive ventilation (NIV) to treat persistent hypercapnic respiratory failure in patients with stable chronic obstructive pulmonary disease (COPD) effectively reduces readmission rates and mortality compared with standard therapy. Traditional workflows around the initiation and management of NIV include elective admission for therapy initiation and frequent face to face clinic visits for follow up, but use of telemedicine offers an alternative approach. Aim This retrospective cohort study evaluated the clinical efficacy and health resource use impact of a remote monitoring approach to the initiation and monitoring of home NIV. Methods Individuals with COPD, COPD obstructive sleep apnoea or obesity related respiratory failure who were started on remote-monitored home NIV from July 2016 to December 2020 were included. Data were obtained from electronic health records. The primary outcome was healthcare utilisation (hospital admissions and average number of bed days) in the 12 months after versus 12 months before starting NIV; secondary endpoints included 2 year survival and time to readmission, and blood gas analysis. Results In the 12 months after versus before NIV initiation, there was a significant reduction in the mean number of admissions (1.0± 2.1 vs. 1.4± 2.1; p<0.0001) and occupied bed days (9.6± 26.8 vs. 17.2± 27.5; p<0.0001); results were consistent across NIV indications. Time to first readmission (hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.58 – 2.8; p<0.001) and time to death (HR 2.25, 95% CI 1.51 – 3.34; p<0.0001) were significantly worse in NIV non users versus users, but did not differ by deprivation quintile. Blood gas analysis showed that NIV significantly reduced carbon dioxide pressure and bicarbonate compared with before NIV. Conclusions A technology assisted service model for the remote initiation and monitoring of home NIV therapy for individuals with chronic hypercapnic respiratory failure was feasible, had a beneficial effect on healthcare utilisation and outcomes, and offset typical adverse relative survival outcomes associated with deprivation.

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Section: Discussionmentioning

confidence: 82%

Impact of remote-monitored home non-invasive ventilation on patient outcomes: a retrospective cohort study

Levey,

Manthe,

Taylor

et al. 2024

Preprint

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Effects of non-invasive ventilation on sleep in chronic hypercapnic respiratory failure

Shah,

Steier,

Hart

et al. 2023

Thorax

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Chronic respiratory disease can exacerbate the normal physiological changes in ventilation observed in healthy individuals during sleep, leading to sleep-disordered breathing, nocturnal hypoventilation, sleep disruption and chronic respiratory failure. Therefore, patients with obesity, slowly and rapidly progressive neuromuscular disease and chronic obstructive airways disease report poor sleep quality. Non-invasive ventilation (NIV) is a complex intervention used to treat sleep-disordered breathing and nocturnal hypoventilation with overnight physiological studies demonstrating improvement in sleep-disordered breathing and nocturnal hypoventilation, and clinical trials demonstrating improved outcomes for patients. However, the impact on subjective and objective sleep quality is dependent on the tools used to measure sleep quality and the patient population. As home NIV becomes more commonly used, there is a need to conduct studies focused on sleep quality, and the relationship between sleep quality and health-related quality of life, in all patient groups, in order to allow the clinician to provide clear patient-centred information.

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A history of home mechanical ventilation: The past, present and future

D’Cruz,

Hart

2024

Chron Respir Dis

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This state-of-the-art review provides an overview of the history of home mechanical ventilation (HMV), including early descriptions of mechanical ventilation from ancient and Renaissance perspectives and the mass development of ventilators designed for long-term use during the poliomyelitis epidemic. Seminal data from key clinical trials supports the application of HMV in certain patients with chronic obstructive pulmonary disease, neuromuscular disease and obesity-related respiratory failure. Innovative engineering coupled with refined physiological understanding now permits widespread delivery of home mechanical ventilation to a global population, using portable devices with advanced ventilatory modes and telemonitoring capabilities. Exponential growth in digital technology continues, and ongoing research is needed to understand how to harness clinical and physiological data to benefit patients and healthcare services in a clinically- and cost-effective manner.

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Cost-effectiveness of home non-invasive ventilation in patients with persistent hypercapnia after an acute exacerbation of COPD in the UK

Cited by 6 publications

References 12 publications

Impact of remote-monitored home non-invasive ventilation on patient outcomes: a retrospective cohort study

Impact of remote-monitored home non-invasive ventilation on patient outcomes: a retrospective cohort study

Effects of non-invasive ventilation on sleep in chronic hypercapnic respiratory failure

A history of home mechanical ventilation: The past, present and future

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