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

Abstract

Purpose To estimate the 5-year budget impact to Aotearoa New Zealand (NZ) hospitals of domiciliary nasal high flow (NHF) therapy to patients with chronic obstructive pulmonary disease (COPD) who require long term oxygen therapy. Methods Hospital admission counts along with length of stay were obtained from hospital records of 200 COPD patients enrolled in a 12-month randomized clinical trial of NHF in Denmark, both over a 12-month baseline and then in the study period while on randomized treatment (control or NHF). NZ costings from similar COPD patients were estimated using data from Middlemore Hospital, Auckland and were applied to the Danish trial. The budget impact of NHF was estimated over the predicted 5-year lifetime of the device when used by patients sequentially. Results Fifty-five of 100 patients in the NHF group and 44 of 100 patients in the control group were admitted to hospital with a respiratory diagnosis during the baseline year. They had 108 admissions in the treatment group vs 89 in the control group, with 632 vs 438 days in hospital, and modeled annual costs of $9443 vs $6512 per patient, respectively. During the study period there were 38 vs 44 patients with 67 vs 80 admissions and 302 vs 526 days in hospital, at a modeled annual cost of $6961 vs $9565 per patient respectively. Taking into account capital expenditure and running costs, this resulted in cost savings of $5535 per patient-year (95% CI, -$36 to -$11,034). With 90% usage over the estimated five-year lifetime of the NHF device, amortized capital costs of $594 per year and annual running costs of $662, we estimate a 5-year undiscounted cost saving per NHF device of $18,626 ($16,934 when discounted to net present value at 5% per annum). There would still be annual cost savings over a wide range of assumptions. Conclusion Domiciliary NHF therapy for patients with severe COPD has the potential to provide substantial hospital cost savings over the five-year lifetime of the NHF device.

Cost-Effectiveness of Humidified High-Flow Therapy (HHFT) for COPD Patients on Long-Term Oxygen Therapy

“…Our findings are similar to those of two recently published health economic studies of HHFT for persons with severe COPD conducted from the Danish 48 and New Zealand 49 healthcare perspectives using the same trial data. The Danish analysis found that the incremental cost-effectiveness ratio for LTOT + HHFT compared to LTOT alone was £3605/ QALY.…”

“…The budget impact analysis from a New Zealand healthcare perspective did not include effectiveness data but found a sizable healthcare cost savings in New Zealand currency. 49 …”

Effect of Supportive Nursing Care on Symptoms Severity and Quality of Life for Patients with Chronic Obstructive Pulmonary Disease.

“…In agreement with the current result, Bafadhel et al (38) indicated that all COPD patients have frequent hospitalizations and re-admissions, which have a significant influence on the prognosis, progress, and mortality of COPD patients, as well as severely limiting their QOL. Also, Milne, Hockey and Garrett (39) proved that COPD was the most common reason for readmissions, estimating for 39.5% and 46.8% of readmissions within thirty and ninety days, respectively.…”

Pressure recordings for monitoring tidal breathing and optimizing settings for nasal high-flow therapy

“…In case of intolerance or failure of NIV, nasal high-flow therapy (NHFT) can be considered as an alternative treatment [18,145]. The therapy can also be effectively used at home, both after hospitalization [30,41] as well as for stable COPD patients [118,123].…”