The economics of COPD therapy 2018 - Part 1

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New study illustrates impact of HOT-HMV on hospital re-admission – and morbidity

Two of the four pillars of the Quadruple Aim of healthcare center explicity on boosting patient outcomes and driving down costs. It is no secret that the two objectives are often intertwined. Healthier patient populations can translate to a less acute ―and expensive ―burden of care on society. And therapies that promote better outcomes, and can be administered away from expensive brick-and-mortar acute care settings (i.e. the hospital), can be a win-win. A recent study¹ suggests the combination of non-invasive ventilation (NIV) and home oxygen therapy (HOT) can do just that. The report reinforces the clinical effectiveness of HOT-HMV while illustrating its economic benefit.

“COPD is a disorder of contradictions. It is undoubtedly one of the most prevalent of the long-term disorders, but remains one of the most under-diagnosed. Science has identified its major risk factors, yet society does little to mitigate them. Diagnostic testing is simple and straightforward, but is often not performed.”

–Teofilo Lee-Chiong, MD

Pulmonologist and Chief Medical Liaison, Philips

A 5-year, UK-based study (n=116) suggests a significantly prolonged time to readmission or death for patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia following a life-threatening respiratory event or exacerbation.

The results

Addition of home NIV to home oxygen therapy prolonged the median time to re-admission from 1.4 months to 4.3 months² ―a breakthrough for COPD therapy.

By the numbers

The potential health economic impact within the US was previously unknown. The new study reports the incremental cost-effectiveness of HOT-HMV in patients with hypercapnic COPD.³

The original trial data were used to develop an economic model, and findings were featured at the 2018 ATS International Conference in an abstract poster presentation from the payer perspective for the U.S. and the UK.

Costs for HOT-HMV patients were:

HOT alone had the following costs:

“Research focuses on therapies to add additional years to one’s life; equally important are interventions to add life to a person’s years. Finally, patients suffer from its disabling impact on lifestyle; however, many persons can lead full lives despite having COPD.”

–Teofilo Lee-Chiong, MD

Pulmonologist and Chief Medical Liaison, Philips

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The base-case incremental cost/QALY (quality adjusted life year) gained was negative $50,856, suggesting HOT-HMV as a less expensive and more effective.

¹G. J. Criner1, Q. Gu2, P. B. Murphy3, L. Fusfeld2, B. Brueggenjuergen4, T. Goss2, N. Hart5; Pulm & Crit Care Med, Temple Univ Hosp, Philadelphia, PA, United States, 2Boston Healthcare, Boston, MA, United States, 3St Thomas Hosp/Lane Fox Unit, Kings College London, London, United Kingdom, 4Institute for Health Economics, Steinbeis University, Berlin, Germany Guys & St Thomas Foundation Trust, London, United Kingdom.

²Murphy PB, et al. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation A Randomized Clinical Trial. JAMA. Published online May 21, 2017. doi:10.1001/jama.2017.4451

³Criner, G. et al, Cost Effectiveness of Home Oxygen Therapy-Home Mechanical Ventilation (HOT-HMV) for Treatment of Chronic Obstructive Pulmonary Disease (COPD) with Chronic Hypercapnic Respiratory Failure Following an Acute Exacerbation of COPD in the United States (US), American Thoracic Society Abstract 2018

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