Non-invasive ventilation at home reduces mortality and healthcare costs in hypercapnic COPD-CRF

According to a recent study, initiating non-invasive home ventilation (NIVH) soon after diagnosis was related to a lower risk of death and a reduction in Medicare spending for patients with chronic obstructive hypercapnic pulmonary disease (COPD) CRF).

As home noninvasive ventilation (NIVH) is gaining increasing acceptance as a viable treatment option for chronic obstructive pulmonary disease patients with chronic respiratory failure (COPD-CRF), it is still unclear what the optimal time to onset of NIVH is and whether NIVH is more effective for some COPD-CRF phenotypes. Therefore, the researchers aimed to study how the timing of NIVH onset affected mortality, hospitalization, emergency room visits (ED), and healthcare costs for patients with different COPD-CRF phenotypes.

Posted in Respiratory medicine, the study results suggest that the sooner NIVH is initiated after diagnosis, the greater the risk reductions in mortality, hospitalizations, emergency room visits and Medicare costs for patients with hypercapnic COPD-CRF. No benefit of NIVH was found in patients with hypoxic or non-specific COPD-CRF.

The data used in this observational, retrospective, and cohort study came from 100% of the research identifiable Medicare service reimbursement claims collected from 2016 to 2020. The study included 499,717 Medicare beneficiaries diagnosed with COPD and IRC between January 2016 and December 2019 .

The treatment group consisted of 6707 (1.3%) patients who received NIVH 2 months after being diagnosed with COPD-CRF. Researchers assigned the treatment group 4 different time windows based on when they started NIVH: 0-7 days, 8-15 days, 16-30 days, or 31-60 days after diagnosis.

The control group included 493,010 (98.7%) patients who did not receive NIVH. Researchers further divided all patients into both the treatment and control groups by assigning them to 3 different COPD-CRF phenotypes: unspecified COPD-CRF, COPD-CRF with hypoxia, and COPD-CRF with hypercapnia.

Overall, NIVH was significantly correlated with improved survival rates in the whole sample and for patients with hypercapnic COPD-CRF. However, the effectiveness of NIVH in reducing the risk of death decreased with increasing time between diagnosis and initiation of NIVH for both the whole sample and patients with hypercapnic COPD-CRF.

For patients with hypercapnic COPD-IRC, the risk of death was significantly reduced by 43% for those who started NIVH 0-7 days after diagnosis, by 31% for those who started 8-15 days after diagnosis. and 16% of those who started 16 days after diagnosis. -30 days after diagnosis. These data suggest that the earlier a patient with hypercapnic COPD-CRD begins NIVH after diagnosis, the lower the risk of death, the researchers noted.

NIVH initiated 0-30 days after diagnosis significantly reduced the risk of hospitalization for patients with hypercapnic COPD-CRF by approximately 23%. NIVH also significantly reduced the risk of emergency room visits (ED) for patients with hypercapnic COPD-CRF who started treatment 0-30 days after diagnosis, but not in the 0-7 or 0-15 days windows.

NIVH did not significantly reduce the risk of death, the risk of hospitalization, or the risk of emergency room visits for patients with hypoxic or unspecified COPD. In contrast, hypoxic COPD patients who started NIVH 16-30 days after diagnosis had a significantly increased risk of death.

Medicare spending in the year following diagnosis correlated with the time of NIVH initiation for patients with hypercapnic COPD-CRF. Onset of NIVH 0-7 days and 0-15 days after diagnosis resulted in a $ 5484 and $ 3412 reduction in Medicare spending, respectively, in the following year. These findings suggest that the sooner a patient with hypercapnic COPD begins NIVH after diagnosis, the greater the health cost savings, the researchers noted.

For patients with hypoxic COPD-IRC, use of NVIH significantly increased Medicare spending in the year following diagnosis. For patients with unspecified COPD-CRF, NIVH that began 8-15 days after diagnosis resulted in a reduction in Medicare spending, but if started at any other time window, increases in spending were observed.

Limitations of this study include retrospective, non-randomized design. Also, because the Medicare 100% RIF statements do not include data from non-paid populations, the results of this study cannot be generalized to these populations.

This study is the first to show an association between early onset of NIVH and a significant reduction in mortality, hospitalizations, and Medicare costs for patients with hypercapnic COPD-CRF, the authors said.

Reference

Frazier WD, DaVanzo JE, Dobson A, Heath S, Mati K. Early initiation of noninvasive home ventilation improves survival and reduces healthcare costs in COPD patients with chronic hypercapnic respiratory failure: a retrospective cohort study. Breathe with. 2022; 200. doi: 10.1016 / j.rmed.2022.106920

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