[Review of reimbursement for instrumental techniques used for assisted coughing and thoracic expansion. A French National Health Authority assessment (HAS)].
BACKGROUND
In France, children with neuromuscular diseases and patients with traumatic spinal cord injuries receive reimbursement for home use of intermittent positive-pressure breathing and mechanical in-exsufflators devices. The aim of the study was to update the indications for reimbursement for these both devices.


METHODS
A literature review was conducted with several bibliographic databases using the main keywords: intermittent positive-pressure breathing, mechanical insufflation, mechanically-assisted cough, airway clearance. Nine health professionals were interviewed during two meetings. One health professional was interviewed via a questionnaire. An estimation of the population treated with in-exsufflators or intermittent positive-pressure breathing was undertaken from consumer data available for all beneficiaries of the health insurance system.


BACKGROUND
The review identified 111 references which included 14 clinical practice guidelines, two systematic reviews and one randomized controlled trial. Some clinical data were available. Clinical practice guidelines were in favor of using intermittent positive-pressure breathing and in-exsufflators in patients with neuromuscular disease and spinal cord injuries. The healthcare professionals emphasized the need to reimburse the patient for home use of intermittent positive-pressure breathing and in-exsufflators. The patient population treated in the identified clinical situations was estimated at 3100 per year.


CONCLUSIONS
Despite the low level of evidence and after interviewing healthcare professionals, the Haute Autorité de santé (HAS) recommended reimbursement of the costs of in-exsufflators (assisted coughing) and intermittent positive-pressure breathing (thoracic expansion) devices in adults and children with neurological and neuromuscular disease, including spinal cord injury.
Haute Autorité de santé (HAS), 5, avenue du Stade-de-France, 93218 Saint-Denis-La-Plaine cedex, France. Electronic address: c.auger@has-sante.fr.
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Auger
Haute Autorité de santé (HAS), 5, avenue du Stade-de-France, 93218 Saint-Denis-La-Plaine cedex, France.
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Schapiro
Haute Autorité de santé (HAS), 5, avenue du Stade-de-France, 93218 Saint-Denis-La-Plaine cedex, France.
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Galmiche
Haute Autorité de santé (HAS), 5, avenue du Stade-de-France, 93218 Saint-Denis-La-Plaine cedex, France.
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Denis
D000328:Adult; D003371:Cough / Q000191:economics / Q000628:therapy*; D005602:France; D006801:Humans; D007345:Insurance Claim Review; D007349:Insurance, Health, Reimbursement; D009313:National Health Programs; D009468:Neuromuscular Diseases / Q000628:therapy; D012121:Respiration, Artificial / Q000191:economics / Q000379:methods; D012138:Respiratory Therapy / Q000191:economics* / Q000379:methods*
Bronchial airway clearance; Désencombrement bronchique; Intermittent positive-pressure ventilation; Lésions médullaires; Maladies neuromusculaires; Neuromuscular diseases; Respiratory disorders; Spinal cord injuries; Troubles respiratoires; Ventilation non invasive