Impact of noninvasive home ventilation on long-term survival in chronic hypercapnic COPD: a prospective observational study

Budweiser, Stephan; Hitzl, A. P.; Jörres, Rudolf A.; Heinemann, Frank; Arzt, Michael; Schroll, Stephan; Pfeifer, Michael

doi:10.1111/j.1742-1241.2007.01427.x

Cited by 54 publications

(65 citation statements)

References 34 publications

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“…Of the 10 controlled studies, five 89,[93][94][95][96] had a prospective design and five appeared to be retrospective analyses of data, although this was not always clearly described. One prospective study 89 used a matched design, which may result in more similar groups at baseline and thus less biased results.…”

Section: Clinical Effectiveness Review Resultsmentioning

confidence: 99%

“…There were no details in one retrospective study, 87 and the other three may have differences in blood gas levels as these determined eligibility for NIV. Three studies 86,96,97 report that NIV patients had more follow-up visits (at hospital or home) than usual-care patients, which may have impacted on the effectiveness of their usual care.…”

Section: Clinical Effectiveness Review Resultsmentioning

confidence: 99%

“…because of mask intolerance) or did not want to continue; however, in three retrospective studies, 86,88,97 levels of blood gases determined eligibility for NIV, and one retrospective study 98 gave no details. All prospective studies 89,[93][94][95][96] and one of the retrospective studies 98 gave details on similarity between NIV and usual-care groups in terms of baseline characteristics, and there appeared to be no major differences. There were no details in one retrospective study, 87 and the other three may have differences in blood gas levels as these determined eligibility for NIV.…”

Section: Clinical Effectiveness Review Resultsmentioning

confidence: 99%

“…The adjusted and unadjusted HRs reported in two controlled studies in post-hospital populations were significantly in favour of NIV (adjusted for LTOT, haemoglobin, age and body mass index 96 and for age, PaO 2 , haemoglobin and haematocrit at discharge 97 ). However, these are observational studies and there is no way of knowing whether or not the estimated HRs are biased because of unmeasured or inappropriate adjustment for confounders.…”

Section: Survivalmentioning

confidence: 99%

“…Most prospective studies (except two 78,96 ) reported secondary outcomes (one or more of FEV 1 , FVC, PaO 2 , PaCO 2 or 6MWD). Secondary outcome results from RCTs only are presented in forest plots (see Secondary outcomes).…”

Section: Overview Of Outcomesmentioning

confidence: 99%

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The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Dretzke

Blissett

Dave

et al. 2015

Health Technol Assess

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BackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospital during an acute exacerbation, evidence supporting home use for more stable COPD patients is limited. In the UK, domiciliary NIV is considered on health economic grounds in patients after three hospital admissions for acute hypercapnic respiratory failure.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of domiciliary NIV by systematic review and economic evaluation.Data sourcesBibliographic databases, conference proceedings and ongoing trial registries up to September 2014.MethodsStandard systematic review methods were used for identifying relevant clinical effectiveness and cost-effectiveness studies assessing NIV compared with usual care or comparing different types of NIV. Risk of bias was assessed using Cochrane guidelines and relevant economic checklists. Results for primary effectiveness outcomes (mortality, hospitalisations, exacerbations and quality of life) were presented, where possible, in forest plots. A speculative Markov decision model was developed to compare the cost-effectiveness of domiciliary NIV with usual care from a UK perspective for post-hospital and more stable populations separately.ResultsThirty-one controlled effectiveness studies were identified, which report a variety of outcomes. For stable patients, a modest volume of evidence found no benefit from domiciliary NIV for survival and some non-significant beneficial trends for hospitalisations and quality of life. For post-hospital patients, no benefit from NIV could be shown in terms of survival (from randomised controlled trials) and findings for hospital admissions were inconsistent and based on limited evidence. No conclusions could be drawn regarding potential benefit from different types of NIV. No cost-effectiveness studies of domiciliary NIV were identified. Economic modelling suggested that NIV may be cost-effective in a stable population at a threshold of £30,000 per quality-adjusted life-year (QALY) gained (incremental cost-effectiveness ratio £28,162), but this is associated with uncertainty. In the case of the post-hospital population, results for three separate base cases ranged from usual care dominating to NIV being cost-effective, with an incremental cost-effectiveness ratio of less than £10,000 per QALY gained. All estimates were sensitive to effectiveness estimates, length of benefit from NIV (currently unknown) and some costs. Modelling suggested that reductions in the rate of hospital admissions per patient per year of 24% and 15% in the stable and post-hospital populations, respectively, are required for NIV to be cost-effective.LimitationsEvidence on key clinical outcomes remains limited, particularly quality-of-life and long-term (> 2 years) effects. Economic modelling should be viewed as speculative because of uncertainty around effect estimates, baseline risks, length of benefit of NIV and limited quality-of-life/utility data.ConclusionsThe cost-effectiveness of domiciliary NIV remains uncertain and the findings in this report are sensitive to emergent data. Further evidence is required to identify patients most likely to benefit from domiciliary NIV and to establish optimum time points for starting NIV and equipment settings.Future work recommendationsThe results from this report will need to be re-examined in the light of any new trial results, particularly in terms of reducing the uncertainty in the economic model. Any new randomised controlled trials should consider including a sham non-invasive ventilation arm and/or a higher- and lower-pressure arm. Individual participant data analyses may help to determine whether or not there are any patient characteristics or equipment settings that are predictive of a benefit of NIV and to establish optimum time points for starting (and potentially discounting) NIV.Study registrationThis study is registered as PROSPERO CRD42012003286.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Clinical Effectiveness Review Resultsmentioning

confidence: 99%

Section: Clinical Effectiveness Review Resultsmentioning

confidence: 99%

Section: Clinical Effectiveness Review Resultsmentioning

confidence: 99%

Section: Survivalmentioning

confidence: 99%

Section: Overview Of Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Dretzke

Blissett

Dave

et al. 2015

Health Technol Assess

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Association of Home Noninvasive Positive Pressure Ventilation With Clinical Outcomes in Chronic Obstructive Pulmonary Disease

Wilson

Dobler

Morrow

et al. 2020

JAMA

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The association of home noninvasive positive pressure ventilation (NIPPV) with outcomes in chronic obstructive pulmonary disease (COPD) and hypercapnia is uncertain.OBJECTIVE To evaluate the association of home NIPPV via bilevel positive airway pressure (BPAP) devices and noninvasive home mechanical ventilator (HMV) devices with clinical outcomes and adverse events in patients with COPD and hypercapnia.

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Noninvasive Ventilation in Chronic Respiratory Failure Associated with COPD

Grinnan

Truwit

2011

A Practical Guide to Mechanical Ventilation

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Impact of noninvasive home ventilation on long-term survival in chronic hypercapnic COPD: a prospective observational study

Cited by 54 publications

References 34 publications

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Association of Home Noninvasive Positive Pressure Ventilation With Clinical Outcomes in Chronic Obstructive Pulmonary Disease

Noninvasive Ventilation in Chronic Respiratory Failure Associated with COPD

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