scholarly journals Cost-effectiveness of home non-invasive ventilation in COPD group GOLD D patients

2021 ◽  
pp. 327-332
Author(s):  
Enikő BERES ◽  
Katalin BABES ◽  
Zsolt-Levente BERES ◽  
Lucia Georgeta DAINA ◽  
Cristian Marius DAINA ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Chronic Obstructive ◽  
Severe Exacerbation ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
Quality Adjusted Life

Introduction. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, estimated to be the third most common cause of death by 2020. The natural evolution of the disease is characterized by frequent exacerbations, severe exacerbations evolving with respiratory acidosis. Introducing home non-invasive ventilation (NIV) in the management of COPD group GOLD (Global Initiative for Chronic Obstructive Lung Disease) D patients generates supplementary costs, but the decreasing of the number of severe exacerbations will decrease the costs of drug treatment and hospitalization. This balance can be verified through a careful study of cost-effectiveness through modern methods of assessing the costs and years of life gained in relation to quality of life. Material and method. This prospective study took place in the Emergency Department of the Bihor County Clinical Emergency Hospital, Oradea, between 01 October 2017 – 31 October2018, with a follow-up period of 2 years. We included 36 Group risk D COPD patients, presented with severe exacerbation that required NIV; the patients were divided into two study groups according to the treatment scheme after discharge (standard medication according to GOLD guidelines and long-term oxygen therapy - LTOT vs. LTOT + NIV). We follow-up at 2 years with the study group, and analyze the following: number of exacerbations (moderate and severe), number of hospitalizations, mortality rate in two years, average costs for the treatment of exacerbations and for stable COPD periods, quality adjusted life year (QALY). Results and discussions. From 36 enrolled, 10 patients benefited from home NIV. The number of exacerbations was significantly lower in the NIV group compared with the LTOT group (1.72±0.79 vs 3.54±1.18). The incremental cost-effectiveness ratio (ICER) showed a net gain of 31% from gross product (GDP) per capita (5,641.71 ± 1,737.0-euro vs 9,272.3 ± 3,681.9 euro) per quality adjusted life year (QALY) for each patient. Conclusions. Introduction home-NIV demonstrated clinical improvement and higher cost-effectiveness over LTOT alone in Class Risk D, COPD patients after discharge following a severe exacerbation. Keywords: chronic obstructive pulmonary disease, non-invasive ventilation, cost-effectiveness, quality adjusted life year,

scholarly journals Intermittent Use of Portable NIV Increases Exercise Tolerance in COPD: A Randomised, Cross-Over Trial

2019 ◽  
Vol 8 (1) ◽  
pp. 94 ◽  
Author(s):  
Ioannis Vogiatzis ◽  
Nikolaos Chynkiamis ◽  
Matthew Armstrong ◽  
Nicholas Lane ◽  
Tom Hartley ◽  
...  
Keyword(s):  
Exercise Tolerance ◽  
Moderate Intensity ◽  
Chronic Obstructive ◽  
Dynamic Hyperinflation ◽  
Invasive Ventilation ◽  
Inspiratory Capacity ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation

During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip breathing (PLB) on exercise tolerance. Twenty-four COPD patients were randomised to a high-intensity (HI: 2-min at 80% peak work rate (WRpeak) alternated with 2-min recovery; n = 13), or a moderate-intensity (MOD: 6-min at 60% WRpeak alternated with 2-min recovery; n = 11) protocol, and within these groups two tests were performed using pNIV and PLB during recovery in balanced order. Upon completion, patients were provided with pNIV; use over 12 weeks was assessed. Compared to PLB, pNIV increased exercise tolerance (HI: by 5.2 ± 6.0 min; MOD: by 5.8 ± 6.7 min) (p < 0.05). With pNIV, mean inspiratory capacity increased and breathlessness decreased by clinically meaningful margins during recovery compared to the end of exercise (HI: by 140 ± 110 mL and 1.2 ± 1.7; MOD: by 170 ± 80 mL and 1.0 ± 0.7). At 12 weeks, patients reported that pNIV reduced anxiety (median: 7.5/10 versus 4/10, p = 0.001) and recovery time from breathlessness (17/24 patients; p = 0.002); 23/24 used the device at least weekly. pNIV increased exercise tolerance by reducing dynamic hyperinflation and breathlessness in COPD patients.

scholarly journals Respiratory support in COPD patients after acute exacerbation with monitoring the quality of support (Rescue2-monitor): an open-label, prospective randomized, controlled, superiority clinical trial comparing hospital- versus home-based acute non-invasive ventilation for patients with hypercapnic chronic obstructive pulmonary disease

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Keyword(s):  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Open Label ◽  
Obstructive Pulmonary Disease ◽  
Free Survival ◽  
Non Invasive ◽  
Randomized Controlled ◽  
Copd Patients ◽  
Non Invasive Ventilation

AbstractChronic obstructive pulmonary disease (COPD) is expected to be the 3rd leading cause of death worldwide by 2020. Despite improvements in survival by using acute non-invasive ventilation (NIV) to treat patients with exacerbations of COPD complicated by acute hypercapnic respiratory failure (AHRF), these patients are at high risk of readmission and further life-threatening events, including death. Recent studies suggested that NIV at home can reduce readmissions, but in a small proportion of patients, and with a high level of expertise. Other studies, however, do not show any benefit of home NIV. This could be related to the fact that respiratory failure in patients with stable COPD and their response to mechanical ventilation are influenced by several pathophysiological factors which frequently coexist in the same patient to varying degrees. These pathophysiological factors might influence the success of home NIV in stable COPD, thus long-term NIV specifically adapted to a patient’s “phenotype” is likely to improve prognosis, reduce readmission to hospital, and prevent death. In view of this conundrum, Rescue2-monitor (R2M), an open-label, prospective randomized, controlled study performed in patients with hypercapnic COPD post-AHRF, will investigate the impact of the quality of nocturnal NIV on the readmission-free survival. The primary objective is to show that any of 3 home NIV strategies (“rescue,” “non-targeted,” and “targeted”) will improve readmission-free survival in comparison to no-home NIV. The “targeted” group of patients will receive a treatment with personalized (targeted) ventilation settings and extensive monitoring. Furthermore, the influence of comorbidities typical for COPD patients, such as cardiac insufficiency, OSA, or associated asthma, on ventilation outcomes will be taken into consideration and reasons for non-inclusion of patients will be recorded in order to evaluate the percentage of ventilated COPD patients that are screening failures. ClinicalTrials.gov NCT03890224. Registered on March 26, 2019.

scholarly journals Cost-effectiveness of domiciliary non-invasive ventilation in patients with chronic obstructive pulmonary disease

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-217463
Author(s):  
James Hall ◽  
Alice Margaret Turner ◽  
Janine Dretzke ◽  
David Moore ◽  
Sue Jowett
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Cost Effective ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
The Cost

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic disease associated with recurring exacerbations, which influence morbidity and mortality for the patient, while placing significant resource burdens on healthcare systems. Non-invasive ventilation (NIV) in a domiciliary setting can help prevent admissions, but the economic evidence to support NIV use is limited.MethodsA Markov model-based cost-utility analysis from the UK National Health Service perspective compared the cost-effectiveness of domiciliary NIV with usual care for two end-stage COPD populations; a stable COPD population commencing treatment with no recent hospital admission; and a posthospital population starting treatment following admission to hospital for an exacerbation. Hospitalisation rates in patients receiving domiciliary NIV compared with usual care were derived from randomised controlled studies in a recent systematic review. Other model parameters were updated with recent evidence.ResultsAt the threshold of £20 000 per quality-adjusted life-year (QALY) domiciliary NIV is 99.9% likely cost-effective in a posthospital population, but unlikely (4%) to be cost-effective in stable populations. The incremental cost-effective ratio (ICER) was £11 318/QALY gained in the posthospital population and £27 380/QALY gained in the stable population. Cost-effectiveness estimates were sensitive to longer-term readmission and mortality risks, and duration of benefit from NIV. Indeed, for stable Global Initiative for Chronic Obstructive Lung Disease (GOLD) for stage 4 patients, or with higher mortality and exacerbation risks, ICERs were close to the £20 000/QALY threshold.ConclusionDomiciliary NIV is likely cost-effective for posthospitalised patients, with uncertainty around the cost-effectiveness of domiciliary NIV in stable patients with COPD on which further research should focus.

scholarly journals Home use of Non-invasive Ventilation for chronic obstructive pulmonary disease. Literature Review and Update.

2021 ◽  
Vol 2 (2) ◽  
pp. 59-63
Author(s):  
Kimiyo Yamasaki
Keyword(s):  
High Intensity ◽  
New Technology ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Admission Rates ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
New Research

Non-invasive ventilation use in acute COPD exacerbation and acute respiratory failure is very strong, however the evidence beyond home non-invasive ventilation for COPD patients is less clear. In this review we summarize the literature on the effectiveness of home non-invasive ventilation on mortality, hospital admission rates, quality of life, lung functions, gas exchange, exercise tolerance as well as mood and anxiety. Published guidelines from multiple societies mostly give weak and conditional guidelines on the use of home non-invasive ventilation. High intensity home non-invasive ventilation was recently introduced and may further improve the outcomes. New research regarding high intensity home non-invasive ventilation and new technology are needed to define the role and the benefits of home non-invasive ventilation in patients with COPD. Keywords: Home non-invasive ventilation, COPD, GOLD

scholarly journals Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Nuttapol Rittayamai ◽  
Prapinpa Phuangchoei ◽  
Jamsak Tscheikuna ◽  
Nattakarn Praphruetkit ◽  
Laurent Brochard
Keyword(s):  
Respiratory Rate ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Obstructive Pulmonary Disease ◽  
Flow Rates ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
Preliminary Study

Abstract Background Non-invasive ventilation (NIV) is preferred as the initial ventilatory support to treat acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease (COPD). High-flow nasal cannula (HFNC) may be an alternative method; however, the effects of HFNC in hypercapnic COPD are not well known. This preliminary study aimed at assessing the physiologic effects of HFNC at different flow rates in hypercapnic COPD and to compare it with NIV. Methods A prospective physiologic study enrolled 12 hypercapnic COPD patients who had initially required NIV, and were ventilated with HFNC at flow rates increasing from 10 to 50 L/min for 15 min in each step. The primary outcome was the effort to breathe estimated by a simplified esophageal pressure–time product (sPTPes). The other studied variables were respiratory rate, oxygen saturation (SpO2), and transcutaneous CO2 pressure (PtcCO2). Results Before NIV initiation, the median [interquartile range] pH was 7.36 [7.28–7.37] with a PaCO2 of 51 [42–60] mmHg. sPTPes per minute was significantly lower with HFNC at 30 L/min than 10 and 20 L/min (p < 0.001), and did not significantly differ with NIV (median inspiratory/expiratory positive airway pressure of 11 [10–12] and [5–5] cmH2O, respectively). At 50 L/min, sPTPes per minute increased compared to 30 L/min half of the patients. Respiratory rate was lower (p = 0.003) and SpO2 was higher (p = 0.028) with higher flows (30–50 L/min) compared to flow rate of 10 L/min and not different than with NIV. No significant differences in PtcCO2 between NIV and HFNC at different flow rates were observed (p = 0.335). Conclusions Applying HFNC at 30 L/min for a short duration reduces inspiratory effort in comparison to 10 and 20 L/min, and resulted in similar effect than NIV delivered at modest levels of pressure support in hypercapnic COPD with mild to moderate exacerbation. Higher flow rates reduce respiratory rate but sometimes increase the effort to breathe. Using HFNC at 30 L/min in hypercapnic COPD patients should be further evaluated. Trial registration Thai Clinical Trials Registry, TCTR20160902001. Registered 31 August 2016, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=2008.

scholarly journals Non-invasive ventilation in the palliative care of patients with chronic obstructive pulmonary disease: a scoping review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048344
Author(s):  
Simen A Steindal ◽  
Kristin Hofsø ◽  
Hanne Aagaard ◽  
Kari L Mariussen ◽  
Brith Andresen ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Scoping Review ◽  
Advisory Board ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation

IntroductionPatients with advanced chronic obstructive pulmonary disease (COPD) experience a great symptom burden. Breathlessness is a very frequently reported symptom that negatively affects all aspects of daily life and could lead to fear of dying. Non-invasive ventilation (NIV) could be an important palliative measure to manage breathlessness in patients with advanced COPD. We decided to conduct a scoping review to attain an overview of the existing research and to identify knowledge gaps. This scoping review aims to systematically map published studies on the use of NIV in the palliative care of COPD patients, including the perspectives and experiences of patients, families and healthcare professionals.Methods and analysisThis scoping review will employ the framework of Arksey and O’Malley. The reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A comprehensive and systematic search strategy will be developed in cooperation with an experienced librarian. Database searches will be conducted in AMED, PEDro, Embase, CINAHL, PsycInfo and MEDLINE in February 2021. Pairs of authors will independently assess studies’ eligibility and extract data using a standardised data-charting form. The data will be inductively summarised and organised thematically. The results will be discussed with an advisory board consisting of nurses and physicians from respiratory and intensive care units.Ethics and disseminationApproval for the workshop with the advisory board has been attained from the Norwegian Centre for Research Data (480222), and approval will be attained from the Personal Data Protection Officers of the participating hospitals. All advisory board participants will sign an informed written consent before participation. The results could contribute to developing the body of evidence on the use of NIV in the palliative care of COPD patients and serve to identify directions for future research.

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