Home non-invasive mechanical ventilation and long-term oxygen therapy in stable hypercapnic chronic obstructive pulmonary disease patients: comparison of costs.
BACKGROUND
A cost analysis of nocturnal non-invasive ventilation (NNV) in stable chronic obstructive pulmonary disease (COPD) patients would be helpful in decision making, when the balance between the increased demand and the availability of resources should be checked.


OBJECTIVE
Based on data from the Italian trial in stable hypercapnic COPD patients, this study compares the cost of care associated with the use of NNV when added to the usual long-term oxygen therapy (LTOT) with the cost of care of LTOT regimen alone.


METHODS
Cost was calculated in 77 of 90 patients included into that trial. Analysis included drug therapy, hospitalisations due to acute exacerbation, oxygen and ventilator equipment. An estimation of charges was made according to the national sources of cost for drugs and hospital admissions and the actualised reimbursement for the home care provided to both oxygen and ventilator users. The cost/day comparison was made between the individual patients in the 2 groups (NNV + LTOT, n = 35; LTOT, n = 42).


RESULTS
The mean cost of drugs and oxygen was similar in both groups, whereas the cost of hospitalisation tended to be lower in NNV + LTOT compared to LTOT alone (8.25 +/-10.29 vs. 12.50 +/- 20.28 EUR/patient/day, p < 0.05). Inclusion of the ventilator equipment increased the total cost to 23.73 EUR/day in the NNV + LTOT compared to 21.42 EUR/day in the LTOT group (not significant).


CONCLUSIONS
The present report suggests that long-term management with addition of non-invasive ventilation does not increase costs compared with the usual LTOT regimen: the hospital-related costs were reduced when using the ventilator in these hypercapnic COPD patients.
Clini
Enrico M
EM
Department of Oncology, Hematology and Pneumology, University of Modena, Ospedale Villa Pineta, Via Gaiato 127, Pavullo n/F, Italy. clini.enrico@unimore.it
Magni
Giovanna
G
Crisafulli
Ernesto
E
Viaggi
Stefano
S
Ambrosino
Nicolino
N
D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000191:economics*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012121:Respiration, Artificial / Q000191:economics*