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Recurrent acidotic exacerbations of COPD

Domiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD: an economic analysis

Tuggey JM, Plant PK, Elliott MW

Background

Patients with chronic obstructive pulmonary disease (COPD) tend to have frequent exacerbations necessitating hospital admission. Each admission has been estimated to cost £3000. The requirement for intensive care significantly increases this cost.

This study looked at the potential for cost savings in a carefully selected group of patients with severe COPD with recurrent admissions due to respiratory acidosis.

Methods

The primary outcome was total hospital costs incurred per patient per year. Effectiveness outcomes were total days in hospital and in intensive care.

Patients

Thirteen patients who had previously tolerated noninvasive ventilation (NIV) well in the hospital setting were offered domiciliary NIV.

Results

Provision of a home NIV service resulted in a mean (95% CI) saving of £8254. Total days in hospital fell from a mean of 78 to 25 (p=0.004), number of admissions from five  to two  (p=0.007), and ICU days fell from a total of 25 to four (p=0.24). Outpatient visits fell from a mean of 5) to 4 (p=0.14).

Cost data per year (n=13) for patients using home NIV vs. patients without home NIV. *Other costs include respiratory nurse, training and outpatient appointments. Adapted from Tuggey et al.

“This study has identified a significant cost benefit to the acute hospital by the provision of a home NIV service for a selected group of patients with recurrent admissions with acidotic exacerbations of COPD.”

Results

References

1

Domiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD: an economic analysis. Thorax 2003; 58(10):867–871.