title: Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities.
abstract: BACKGROUND
  The majority of Indian hospitals do not provide intensive care unit (ICU) care or ward-based noninvasive positive pressure ventilation (NIV). Because no mechanical ventilation or NIV is available in these hospitals, the majority of patients suffering from respiratory failure die.
  
  
  OBJECTIVE
  To perform a cost-effective analysis of two strategies (ward-based NIV with concurrent standard treatment vs standard treatment alone) in chronic obstructive pulmonary disease (COPD) respiratory failure patients treated in Indian hospitals without ICU care.
  
  
  METHODS
  A decision-analytical model was created to compare the cost-effectiveness for the two strategies. Estimates from the literature were used for parameters in the model. Future costs were discounted at 3%. All costs were reported in USD (2012). One-way, two-way, and probabilistic sensitivity analysis were performed. The time horizon was lifetime and perspective was societal.
  
  
  RESULTS
  The NIV strategy resulted in 17.7% more survival and was slightly more costly (increased cost of $101 (USD 2012) but resulted in increased quality-adjusted life-years (QALYs) (1.67 QALY). The cost-effectiveness (2012 USD)/QALY in the standard and NIV groups was $78/QALY ($535.02/6.82) and $75/QALY ($636.33/8.49), respectively. Incremental cost-effectiveness ratio (ICER) was only $61 USD/QALY. This was substantially lower than the gross domestic product (GDP) per capita for India (1489 USD), suggesting the NIV strategy was very cost effective. Using a 5% discount rate resulted in only minimally different results. Probabilistic analysis suggests that NIV strategy was preferred 100% of the time when willingness to pay was >$250 2012 USD.
  
  
  CONCLUSIONS
  Ward-based NIV treatment is cost-effective in India, and may increase survival of patients with COPD respiratory failure when ICU is not available.
authors.affiliation: Department of Emergency Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Shraddha P
authors.initials: SP
authors.lastname: Patel
authors.affiliation: Department of Emergency Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Margarita E
authors.initials: ME
authors.lastname: Pena
authors.affiliation: Department of Emergency Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan, USA.
authors.forename: Charlene Irvin
authors.initials: CI
authors.lastname: Babcock
keywords: Chronic obstructive pulmonary disease; USD/quality-adjusted life-year; cost-effectiveness of ward-based NIV; no access to intensive care unit care; noninvasive positive pressure ventilation; respiratory failure