Initiation of non-invasive home mechanical ventilation in the hospital compared with initiation at home;The Dutch Homerun trial

Introduction: There is an increasing demand for starting Home Mechanical Ventilation (HMV) in patients with chronic respiratory insufficiency. As recommended in our national guideline, it starts currently in a clinical setting, at the 4 Dutch university centres for HMV. Besides the high societal costs, and the discomfort for the patient’s initiation of HMV is often delayed due to lack of hospital bed capacity. Aim: We hypothesize that initiation of HMV at home in a nationwide study, by using telemonitoring, is not inferior compared to initiation in hospital. Methods: The primary outcome is change of arterial carbon dioxide (PaCO₂) after 6 months, while quality of life (SRI, MRF28, HADS, SF36) and costs were secondary outcomes. We conduct a nationwide randomised controlled non-inferiority trial, in which every centre included 24 patients (home (n=12) vs hospital (n=12)) with neuromuscular disease or thoracic cage abnormality with an indication to start HMV. Results: A total of 608 patients is screened, and 96 patients are randomized. We find a significant improvement of the PaCO₂ within both groups (home 6.1 kPa to 5.6 kPa (p <0.01) and hospital 6.3 kPa to 5.6 kPa (p<0.01)). The difference between both groups is not significant. Quality of life (QoL) questionnaires show a significant improvement in various subscales within groups and not significantly different between both groups. A cost reduction over €3200,- per patient in the home group is realized. Conclusion: Initiation at home of HMV for this group of patients is non-inferior to hospital initiation, as it shows the same improvement in gas exchange and QoL. Moreover, starting at home saves over €3200 per patient.