ATS 2018 Perspectives - Episode 12
New data, presented at the 2018 American Thoracic Society (ATS) International Conference in San Diego, California, suggests that combining home oxygen therapy (HOT) with home non-invasive ventilation (HMV) as treatment for chronically hypercapnic chronic obstructive pulmonary disease (COPD) is more effective and cost-efficient than HOT alone.
Researchers compared the accumulated costs of devices, doctor visits, medications and hospitalizations to HOT alone using a US economic model, and concluded that HOT-HMV saved on average per year, $3927 per patient.
“If you can keep people out of the hospital that’s usually going to be cost-effective. In the US, admissions to the hospital are very expensive, they are less expensive in the UK, which is why the study indicated even greater cost-effectiveness in the US than it did in the UK,” David White, MD, chief scientific officer, Philips Respironics, professor of medicine, Harvard Medical School, told MD Magazine. “In the US, the holy grail with COPD these days is keeping them out of the hospital, particularly these people that are exacerbating frequently, because a hospitalization in that setting costs $20,000 plus, and if you can avoid 1 hospitalization, that’ll cover way over the cost of the equipment.”
The data, obtained by an economic analysis of a Philips-sponsored clinical trial of 116 patients in the UK, suggests that the combination of non-invasive ventilation (NIV) and HOT can significantly prolong time to readmission or death for patients with COPD following a life-threatening respiratory event or exacerbation. The 5-year study resulted in prolonged median time to readmission or death by nearly 3 months and improved patient health-related quality of life in the first 6 weeks.
The original data were used to develop an economic model from a US payer perspective, which was presented at this year’s ATS meeting. The analysis indicated the base-case incremental cost per quality-adjusted life year (QALY) gained was negative $50,856, recommending HOV-HMV both in order to save costs and improve quality of life compared to HOT alone.
The economic analysis enrolled patients with a hospital admission due to an exacerbation of COPD requiring active NIV with chronic hypercapnia 2—4 weeks following resolution of respiratory acidosis.
Those patients enrolled in the control arm were permitted to have HMV added to HOT if the primary endpoint, hospital readmission, was met, and if preset safety criteria were breached like persistent acidosis and inability to wean from NIV.
The analysis included patient-level evaluation of equipment, patient-reported medication, physician office visits and hospital admissions because of exacerbations.
Costs were calculated by multiplying observed medical resource utilization by standard unit costs and summed at the patient level.
Analysis results included information from 28/59 HOT patients and 36/57 HOT-HMV patients that completed the 12-month study, with 17 patients allocated to HOT receiving additional HMV.
Researchers concluded that within 30 days, hospital readmission was 58.3% lower in the intervention group. The total costs were $24,458 for HOT-HMV and $28,386 for HOT alone. Patients on HOT-HMV, costs were $4,298 for devices, $10,805 for doctor visits, $758 for medication, and $8,598 for exacerbations; while costs for HOT alone were $1,582, $15,033, $1,088, and $10,683, respectively.
Per the bootstrap analysis, the probability indicated for HOT-HMV to both save costs and improve quality of life is 75.7%.
A similar analysis conducted in the UK also indicated cost-effectiveness and demonstrated greater device costs, a savings of £2,328 per patient in doctor visits, medication and hospitalization costs.
Asked about how these data will better help clinicians treat patients managing COPD, White recommends putting patients that are chronically hypercapnic on NIV to not only reduce costs for the health care system but improve patient’s lives.
Philips Respironics is currently working on a novel way to manage NIV in this patient population. The device, which will be coming out in the next 6—12 months, aims to make it more comfortable and easier for COPD patients to utilize NIV.