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

2015 ◽  
Vol 19 (81) ◽  
pp. 1-246 ◽  
Author(s):  
Janine Dretzke ◽  
Deirdre Blissett ◽  
Chirag Dave ◽  
Rahul Mukherjee ◽  
Malcolm Price ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hospital Admissions ◽  
Cost Effective ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
The Cost ◽  
Effectiveness Studies

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.

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.

Effect of non‐invasive ventilation on survival, quality of life, respiratory function and cognition: A review of the literature

2006 ◽  
Vol 7 (4) ◽  
pp. 195-200 ◽  
Author(s):  
Sanne Piepers ◽  
Jan‐Paul Van Den Berg ◽  
Sandra Kalmijn ◽  
W‐Ludo Van Der Pol ◽  
John H. J. Wokke ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Respiratory Function ◽  
Invasive Ventilation ◽  
Review Of The Literature ◽  
Non Invasive ◽  
Non Invasive Ventilation

Exploring the feasibility of a music-assisted relaxation intervention to assist with the initiation of non-invasive ventilation in people with Motor Neuron Disease

2017 ◽  
Vol 9 (2) ◽  
pp. 86
Author(s):  
Jeanette Tamplin ◽  
Felicity A Baker ◽  
Rebecca Davies ◽  
Eleanor Bajo ◽  
Karen Bolger ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Motor Neuron ◽  
Motor Neuron Disease ◽  
Qualitative Data ◽  
Small Sample ◽  
Invasive Ventilation ◽  
Positive Effects ◽  
Non Invasive ◽  
Non Invasive Ventilation

Background: Transitioning to non-invasive ventilation (NIV) can cause anxiety in people with Motor Neuron Disease (MND), which may reduce adherence rates. Music therapy has demonstrated positive effects with mechanical (invasive) ventilation.Method: This feasibility study examined the effects of music-assisted relaxation (MAR) on NIV adherence, anxiety, and quality of life for people with MND. Data were collected at baseline, 7-days post, and 3-months post NIV implementation.Results: Of 18 consenting participants, 15 chose the MAR condition. Results suggested that supporting NIV transition within the first 7 days may be advantageous for long-term adherence. No effects were found for anxiety or quality of life. Limitations included small sample size, lack of an adequate control, and possible ceiling effects on the instruments used. Qualitative data indicated most participants considered the relaxing and distracting effects of MAR were useful.Conclusions: In this small sample, we found some demand for and acceptability of a music-based intervention in this setting. Participants reported differing experiences of using MAR, and there were technical and logistical issues regarding timely and accessible provision of a MAR intervention within the treatment trajectory of NIV implementation. Conflicting quantitative and qualitative data support the need for mixed method research in this area.

scholarly journals Understanding the Cost-Effectiveness of Hearing Aids and Surgery for the Treatment of Otosclerosis

2022 ◽  
Author(s):  
Danielle M. Gillard ◽  
Jeffrey D. Sharon
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hearing Aids ◽  
Cost Effective ◽  
Stapes Surgery ◽  
Cost Effective Method ◽  
Patient Reported ◽  
Complications Of Surgery ◽  
The Cost

Abstract Purpose of Review To summarize and critically review recent literature on the relative cost-effectiveness of hearing augmentation versus stapes surgery for the treatment of otosclerosis. Recent Findings Otosclerosis leads to reduced patient quality of life, which can be ameliorated by either stapes surgery, or hearing aid usage. The success of stapes surgery is high, and the risks of serious postoperative complications are low. Hearing aids don’t have the complications of surgery but are associated with long-term costs. Cost-effectiveness models have shown that stapes surgery is a cost-effective method for treating otosclerosis. Summary Both stapes surgery and hearing aids can improve patient-reported quality of life in otosclerosis. Stapes surgery has larger upfront costs and surgical risks, but hearing aids are associated with longer lifetime costs. Stapes surgery is cost-effective for the treatment of otosclerosis.

Predictors of health-related quality of life in COPD-patients on long-term non-invasive ventilation

2021 ◽  
Author(s):  
Maximilian Wollsching-Strobel ◽  
Sarah Schwarz ◽  
Pouya Heidari ◽  
Daniel Sebastian Majorski ◽  
Friederike Sophie Magnet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Invasive Ventilation ◽  
Health Related Quality ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
Related Quality ◽  
Health Related

scholarly journals Living conditions and autonomy levels in COPD patients receiving non-invasive ventilation: impact on health related quality of life

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Bettina Schwarz ◽  
Tim Mathes ◽  
Daniel Sebastian Majorski ◽  
Maximilian Wollsching-Strobel ◽  
Doreen Kroppen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Rehabilitation ◽  
Invasive Ventilation ◽  
Health Related Quality ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
Related Quality ◽  
Health Related

Abstract Background Research on health-related quality of life (HRQL) has become increasingly important in recent decades. However, the impact of both living conditions and the level of autonomy impairments on HRQL in COPD patients receiving non-invasive ventilation (NIV) is still unclear. Methods The Severe Respiratory Insufficiency Questionnaire (SRI) was used to measure HRQL in a prospective cohort of COPD patients in whom home NIV was already established. Data on sociodemographics, clinical characteristics and standardized levels of autonomy impairment were evaluated. A multiple linear regression analysis was performed to identify the factors associated with a reduced HRQL. Results A total of 137 patients (67.0 ± 7.8 years, 45% female) were assessed. The mean SRI Summary Score was 54.1 ± 16.9 (95%CI: 51.1–57.1; N = 127). Regular ambulatory care was provided in 76% of patients, but only 37% underwent pulmonary rehabilitation. Overall, 69% of patients lived with family members, while 31% lived alone (family situation). Autonomy impairment levels were most serious in 3%, serious in 14%, and significant in 29% of patients, while 54% had no impairments at all. Of note, higher levels of autonomy impairment were markedly associated with lower SRI scores (regression coefficient − 6.5 ± 1.1 per level; P < 0.001). In contrast, family situation (0.2 ± 3.0; P = 0.959), ambulatory care by a respiratory specialist (1.7 ± 3.6; P = 0.638), and pulmonary rehabilitation (− 0.8 ± 3.1; P = 0.802) did not appear to influence HRQL. Possible subgroup effects were evident for the factors “impaired autonomy” and “living in a nursing home” (P = 0.016). Conclusion A higher level of autonomy impairment has been identified as the major determinant of reduced HRQL in COPD-patients receiving long-term NIV, particularly in those living in a nursing home. Trial Registration German Clinical Trials Register (DRKS00008759).

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