Health care utilization and costs in children receiving home mechanical ventilation: a 14-year cohort study

SESSION TITLE: Pediatrics Pulmonary Potpourri SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:55 pm - 01:40 pm PURPOSE: Children using home mechanical ventilation (HMV) is a growing population; however, there is limited knowledge regarding healthcare utilization and costs using robust administrative data. Our primary objective was to describe the patterns of healthcare utilization and costs in children with HMV over a 14-year period in Ontario, Canada. Our secondary objective was to identify predictors of increased healthcare costs in this population. METHODS: A retrospective cohort study of children aged 0-18 years receiving HMV via invasive mechanical ventilation (IMV) or non-invasive ventilation (NIV) was conducted using health administrative databases from April 1, 2003, to March 31, 2017. Paired t-tests compared health system utilization and costs two years before and two years after HMV approval. Least square models assessed for predictors of increased utilization and costs. RESULTS: We identified a total of 835 children receiving HMV. Compared to two years before HMV approval, children after two years of HMV had decreased hospitalization days (mean (SD) 29.8 (57.1) versus 71.5 (57.9), p<0.0001) and ICU admission days (18.7 (36.4) versus 53.6 (81.2), p<0.0001) but had increased usage of homecare services (292.2 (294.6) versus 155.6 (225.5), p<0.0001) and outpatient Respirology consults (3.4 (2.8) versus 2.5 (3.2), p=0.001). Total healthcare costs were higher in children in the two years after HMV approval compared to before HMV approval (CAD $164,892 ($214,187) versus $128,941 ($194,199), p<0.0001) with significant rises in costs of investigations, emergency department visits, and homecare services. However, HMV approval led to reduced all-cause hospital admission costs ($66,546 ($142,401) versus $81,578 ($164,672), p<0.0001). Higher total costs in children were associated with IMV (OR 3.45, 95% CI 2.24-5.31), number of medical technologies at home (OR 1.63, 95% CI 1.35-1.96), and increased healthcare costs one year prior to HMV (OR 1.76, 95% CI 1.51-2.04). CONCLUSIONS: The initiation of HMV appears to shorten the duration and reduce the costs of hospitalizations. However, although inpatient costs may be lower after HMV approval, there may be an increase in costs related to outpatient services such as homecare support, ambulatory clinic visits, and investigations. Additionally, total costs increase after initiation of HMV, especially with the use of IMV, likely due to the requirements for greater expert supervision and regular maintenance with additional supplies and equipment. CLINICAL IMPLICATIONS: Children with HMV have significant patterns of healthcare utilization and costs. Understanding the long-term financial implications of HMV remains an urgent priority. Prospective studies are encouraged to investigate long-term financial implications of children receiving HMV and to examine strategies to improve support for these families at home. DISCLOSURES: No relevant relationships by Reshma Amin No disclosure on file for Yu Qing Bai No relevant relationships by Eyal Cohen Early Career Mentoring Committee relationship with Novartis Please note: 2021-2022 Added 03/31/2023 by Andrea Gershon, source=Web Response, value=Stipend No relevant relationships by Astrid Guttmann No relevant relationships by Sherri Katz No relevant relationships by Audrey Lim No relevant relationships by Louise Rose No relevant relationships by Rahul Verma No relevant relationships by Lena Xiao