#ATS2018 — Combined COPD Treatments Could Be Effective Cost-Saving Strategy, Study Says

Combining home oxygen therapy (HOT) with home noninvasive ventilation (HMV) could be more effective and less expensive than HOT alone for certain patients with chronic obstructive pulmonary disease (COPD), a study suggests.

Sponsored by the health technology company Royal Philips, the study offers an economic analysis showing potential cost savings of more than $3,900 per patient in the U.S. when combining these two types of at-home therapy. Findings were recently presented at the American Thoracic Society (ATS) Conference 2018 in San Diego.

The study involved COPD patients who also suffer from chronic hypercapnia, a condition in which abnormally high carbon dioxide (CO2) levels are found in the blood.

“Patients who suffer from COPD and face frequent hospitalization due to their disease previously had limited treatment and care options available to them,” Nicholas Hart, PhD, clinical director of Lane Fox Respiratory Service at St. Thomas’ Hospital in London, said in a press release. “We’re all searching for healthcare solutions that improve patient outcomes, but are also economically feasible — and scalable. For that reason, it’s exciting to see data showing we can achieve both of these through a combination of therapies.”

The Home Oxygen Therapy-Home Mechanical Ventilation (HOT-HMV) clinical trial (NCT00990132) followed for five years 116 patients who were being treated at St. Thomas’ Hospital in London and other centers.

Results from this study were previously presented at ATS 2017 and published in the Journal of American Medical Association, but its economic impact remained unknown.

Researchers have now used original trial data to develop an economic model from the perspective of U.S. payers. This analysis showed that the incremental cost per quality-adjusted life year (QALY) gained was negative.

More specifically, in the U.S., total costs were $24,458 for HOT-HMV and $28,386 for HOT alone. For HOT-HMV patients, costs were $4,298 for devices, $10,805 for doctor visits, $758 for medication, and $8,598 for exacerbations; while corresponding costs for HOT alone were $1,582 for devices, $15,033 for doctor visits, $1,088 for medication, and $10,683 for exacerbations.

These findings suggest that, with an average annual cost savings of $3,927 per patient, HOT-HMV could be effective both in terms of saving patients money and improving quality of life compared with HOT alone.

A similar analysis in the U.K. showed savings of £2,328 per patient (about $3,090) between HOT-HMV and HOT alone.

“COPD greatly impacts patients’ quality of life due to the high potential for hospital admissions and disease burden, which results in increasing healthcare costs,” said David White, MD, chief medical officer at Philips. “These findings support the use of oxygen paired with non-invasive ventilation in the home to improve the patient experience and pave the way for more cost effective care.”

Home oxygen therapy (HOT) involves breathing air that contains more oxygen than normal from a cylinder or machine at home. Home noninvasive ventilation (HMV) is a method to assist a patient’s breathing trough a nasal or facial mask that is attached to a portable ventilator that produces a rapid flow of gas (air or oxygen) opening the airways.