COST-EFFECTIVENESS OF HOME OXYGEN THERAPY-HOME MECHANICAL VENTILATION (HOT-HMV) FOR TREATMENT OF COPD WITH CHRONIC HYPERCAPNIC RESPIRATORY FAILURE FOLLOWING AN ACUTE EXACERBATION OF COPD IN THE US

SESSION TITLE: Improving Care in COPD SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 01:30 PM - 02:30 PM PURPOSE: In the UK trial of HOT-HMV, delayed time to readmission was reported in patients (pts) with persistent hypercapnia following a life-threatening exacerbation of COPD requiring acute non-invasive ventilation (NIV) (Murphy et al., JAMA 2017). The health economic impact of HOT-HMV in the US has been previously reported using costs for a respiratory assist device with a -$50,856 /quality-adjusted life year (QALY) (Criner et al ATS 2018). The current study reports the incremental cost-effectiveness (CE) of HOT-HMV with a home ventilator device. METHODS: The analysis included pt-level use of equipment (O2 concentrator, home NIV device, maintenance and support), from the intent-to-treat analysis of an open-label parallel-group randomized clinical trial. Pts with a hospitalization due to a COPD exacerbation requiring acute NIV with persistent hypercapnia 2-4 weeks following resolution of respiratory acidosis were enrolled. Pts in the control arm were permitted to have HMV added to HOT if the primary end-point (hospital readmission) was met & if pre-set safety criteria were breached (e.g. persistent acidosis & inability to wean from NIV). The analysis included medical resource utilization (MRU) of patient-level evaluation of equipment (oxygen concentrator & ventilator NIV device, including maintenance & support), patient-reported medication, physician office visits, & hospital admissions due to exacerbations. Trial data were used to develop an economic model from the US payer perspective. Costs were calculated by multiplying observed MRU by standard unit costs (2018$) & summed at the pt level. QALYs were measured based on patient health utilities calculated with US coefficients & EuroQOL EQ-5D data from the trial. One-way sensitivity and bootstrap analyses with 1,000 iterations were completed. RESULTS: 28/59 HOT pts & 36/57 HOT-HMV pts completed the 12-month study; 17 pts allocated to HOT received additional HMV. Rehospitalization w/i 30 days was 58.3% lower in the intervention group. The base-case incremental cost/QALY gained was $24,375, suggesting HOT-HMV is cost-effective with the higher cost of a home ventilator. Total costs were $32,330 for HOT-HMV & $30,447 for HOT alone. HOT-HMV patient costs were $11,973 for devices, $10,910 for doctor visits, $758 for medication, & $8,689 for exacerbations; corresponding costs for HOT alone were $3,383, $15,179, $1,087, & $10,798. One-way sensitivity analysis suggests that the home ventilator device cost has the greatest impact on cost/QALY. A bootstrap analysis indicates the probability for HOT-HMV being more expensive & more effective is 60.4%. CONCLUSIONS: These data support the cost-effectiveness of HOT-HMV using a home ventilator device for treatment in the U.S. CLINICAL IMPLICATIONS: In addition to the clinical effectiveness of HOT-HMV as previously reported, these data support the cost effectiveness of HOT-HMV using a home ventilator device for treatment. DISCLOSURES: no disclosure on file for Bernd Brüggenjürgen; Advisory Committee Member relationship with GSK, BI, Chiesi, Pulmonx, BTG, Novartis, Mereo Please note: $1001 - $5000 Added 03/01/2018 by Gerard Criner, source=Web Response, value=Consulting fee Consultant relationship with GSK, BI, novartis, Mereo, Prometic, Pulmonx, BTG, Pneumrx Please note: $1001 - $5000 Added 06/01/2018 by Gerard Criner, source=Web Response, value=Consulting fee Consultant relationship with Resmed and Philips Please note: >$100000 Added 03/16/2018 by Lauren Fusfeld, source=Web Response, value=Consulting fee Employee relationship with Boston Healthcare Associates Please note: >$100000 Added 03/03/2018 by Thomas Goss, source=Web Response, value=Grant/Research SupportRemoved 03/03/2018 by Thomas Goss, source=Web Response Employee relationship with Boston Healthcare Associates Please note: >$100000 Added 03/03/2018 by Thomas Goss, source=Web Response, value=SalaryRemoved 03/03/2018 by Thomas Goss, source=Web Response Consultant relationship with ResMed Please note: $20001 - $100000 Added 03/03/2018 by Thomas Goss, source=Web Response, value=Grant/Research Support Consultant relationship with Philips Respironics Please note: $20001 - $100000 Added 03/03/2018 by Thomas Goss, source=Web Response, value=Grant/Research Support Consultant relationship with Resmed Please note: $5001 - $20000 Added 03/05/2018 by Qing Gu, source=Web Response, value=Grant/Research Support no disclosure on file for Nicholas Hart; Speaker/Speaker's Bureau relationship with Philips respironics Please note: $1-$1000 Added 03/15/2018 by Patrick Murphy, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with ResMed Please note: $1-$1000 Added 03/15/2018 by Patrick Murphy, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Breas Please note: $1-$1000 Added 03/15/2018 by Patrick Murphy, source=Web Response, value=Honoraria