Cost-Minimization Analysis of Non-Invasive and Invasive Mechanical Ventilation for De Novo Acute Hypoxemic Respiratory Failure in an Eastern European Setting

Ilieva, V.; Mihalova, T.; Yamakova, Yo.; Petkov, R.; Velev, B.

doi:10.2478/amb-2019-0003

Abstract

Introduction: In the light of constant pressure for minimizing healthcare costs we made a cost-minimization analysis comparing invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV) as treatment for hypoxemic acute respiratory failure (ARF).

Aim: The primary objective was to estimate the direct medical costs generated by a patient on IMV and NIV. A secondary objective was to identify which aspect of the treatment was most expensive.

Material and Methods: This is a single center retrospective study including 36 patients on mechanical ventilation due to hypoxemic ARF, separated in two groups – NIV (n = 18) and IMV (n = 18). We calculated all direct medical costs in Euro and compared them statistically.

Results: On admission the PaO₂/FiO₂ and SAPS II score were comparable in both groups. We observed a significant difference in the costs per patient for drug treatment (NIV: 616.07; IQR: 236.68, IMV:1456.18; IQR:1741.95, p = 0.005), consumables (NIV: 16.47; IQR: 21.44, IMV: 98.79; IQR: 81.52, p < 0.001) and diagnostic tests (NIV: 351; IQR: 183.88, IMV: 765.69; IQR: 851.43, p < 0.001). We also computed the costs per patient per day and there was a significant difference in the costs in all above listed categories. In both groups the highest costs were for drug treatment – around 61%.

Conclusions: In the setting of hypoxemic ARF NIV reduces significantly the direct medical costs of treatment in comparison to IMV. The decreased costs in NIV are not associated with severity of disease according to the respiratory quotient and SAPS II score.

References

1. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50:1602426.10.1183/13993003.02426-201628860265
Search in Google Scholar Back to article
2. Nicolini A, Stieglitz S, Bou-Khalil P, Esquinas A. Cost-utility of non-inasive mechanical ventilation: Analysis and implications in acute respiratory failure. A brief narrative review. Respr Investig. 2018;56(3):207-13.10.1016/j.resinv.2017.12.01129773291
Search in Google Scholar Back to article
3. Mandell A, Wunderink R, Anzueto A et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis. 2007;44:S27-72.10.1086/511159710799717278083
Search in Google Scholar Back to article
4. British Thoracic Society Standards of Care Committee. BTS guideline: Non-invasive ventilation in acute respiratory failure. Thorax. 2002;57:192-211.10.1136/thorax.57.3.192174628211867822
Search in Google Scholar Back to article
5. Nava S, Evangelisti I, Rampulla C et al. Human and financial costs of noninvasive mechanical ventilation in patients affected by COPD and acute respiratory failure. Chest. 1997;111(6):1631-8.10.1378/chest.111.6.16319187186
Search in Google Scholar Back to article
6. Keenan SP, Gregor J, Sibbald WJ et al. Noninvasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease: more effective and less expensive. Crit Care Med. 2000;28(6):2094-102.10.1097/00003246-200006000-0007210890671
Search in Google Scholar Back to article
7. Criner GJ, Kreimer DT, Tomaselli M et al. Financial implications of noninvasive positive pressure ventilation (NPPV). Chest. 1995;108:475-82.10.1378/chest.108.2.4757634887
Search in Google Scholar Back to article
8. Plant PK, Owen JL, Parrott S, Elliot MW. Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial. Br Med J. 2003;326(7396):956.10.1136/bmj.326.7396.95615385012727767
Search in Google Scholar Back to article
9. Patel SP, Pena M, Babcock CI. Cost effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease related respiratory failure in Indian hospital without ICU facilities. Lung India. 2015;32(6):549-56.10.4103/0970-2113.168137466385526664158
Search in Google Scholar Back to article
10. Ornek T, Tor M, Altin R et al. Clinical factors affecting the direct cost of patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Int J Med Sci. 2012;9(4):285-90.10.7150/ijms.4039337293422701335
Search in Google Scholar Back to article
11. Bertolini G, Confalonieri M, Rossi C et al. Costs of the COPD. Differences between intensive care unit and respiratory intermediate care unit. Respir Med. 2005;99:894-900.10.1016/j.rmed.2004.11.01415939252
Search in Google Scholar Back to article
12. Chandra K, Blackhouse G, Campbell M, Costa KV. Cost-effectiveness of interventions for chronic obstructive pulmonary disease (COPD) using an Ontario policy model. Ont Health Technol Assess Ser. 2012;12(12):1-61.
Search in Google Scholar Back to article
13. Girou E, Schortgen F, Delclaux C et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA. 2000;284(18):2361-7.10.1001/jama.284.18.236111066187
Search in Google Scholar Back to article
14. Nourdine K, Combes P, Carton MJ et al. Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. Intensive Care Med. 1999;25(6):567-73.10.1007/s00134005090410416907
Search in Google Scholar Back to article
15. Chevrolet JC, Jolliet P, Abajo B et al. Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses. Chest. 1991;100(3):775-82.10.1378/chest.100.3.7751889272
Search in Google Scholar Back to article

Cost-Minimization Analysis of Non-Invasive and Invasive Mechanical Ventilation for De Novo Acute Hypoxemic Respiratory Failure in an Eastern European Setting

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