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Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities.

Patel SP, Pena ME, Babcock CI - Lung India (2015 Nov-Dec)

Bottom Line: Incremental cost-effectiveness ratio (ICER) was only $61 USD/QALY.This was substantially lower than the gross domestic product (GDP) per capita for India (1489 USD), suggesting the NIV strategy was very cost effective.Using a 5% discount rate resulted in only minimally different results.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan, USA.

ABSTRACT

Introduction: The majority of Indian hospitals do not provide intensive care unit (ICU) care or ward-based noninvasive positive pressure ventilation (NIV). Because no mechanical ventilation or NIV is available in these hospitals, the majority of patients suffering from respiratory failure die.

Objective: To perform a cost-effective analysis of two strategies (ward-based NIV with concurrent standard treatment vs standard treatment alone) in chronic obstructive pulmonary disease (COPD) respiratory failure patients treated in Indian hospitals without ICU care.

Materials and methods: A decision-analytical model was created to compare the cost-effectiveness for the two strategies. Estimates from the literature were used for parameters in the model. Future costs were discounted at 3%. All costs were reported in USD (2012). One-way, two-way, and probabilistic sensitivity analysis were performed. The time horizon was lifetime and perspective was societal.

Results: The NIV strategy resulted in 17.7% more survival and was slightly more costly (increased cost of $101 (USD 2012) but resulted in increased quality-adjusted life-years (QALYs) (1.67 QALY). The cost-effectiveness (2012 USD)/QALY in the standard and NIV groups was $78/QALY ($535.02/6.82) and $75/QALY ($636.33/8.49), respectively. Incremental cost-effectiveness ratio (ICER) was only $61 USD/QALY. This was substantially lower than the gross domestic product (GDP) per capita for India (1489 USD), suggesting the NIV strategy was very cost effective. Using a 5% discount rate resulted in only minimally different results. Probabilistic analysis suggests that NIV strategy was preferred 100% of the time when willingness to pay was >$250 2012 USD.

Conclusion: Ward-based NIV treatment is cost-effective in India, and may increase survival of patients with COPD respiratory failure when ICU is not available.

No MeSH data available.


Related in: MedlinePlus

Decision tree
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Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4663855&req=5

Figure 1: Decision tree

Mentions: The model used in the analysis was a decision tree with one-way sensitivity analysis, two-way sensitivity analysis, and probabilistic (Monte Carlo) analysis. Estimates for variables in the model were drawn from the literature. Figure 1 reveals the decision tree utilized in the analysis. Table 1 reveals the estimates used in the model, and the sources.


Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities.

Patel SP, Pena ME, Babcock CI - Lung India (2015 Nov-Dec)

Decision tree
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663855&req=5

Figure 1: Decision tree
Mentions: The model used in the analysis was a decision tree with one-way sensitivity analysis, two-way sensitivity analysis, and probabilistic (Monte Carlo) analysis. Estimates for variables in the model were drawn from the literature. Figure 1 reveals the decision tree utilized in the analysis. Table 1 reveals the estimates used in the model, and the sources.

Bottom Line: Incremental cost-effectiveness ratio (ICER) was only $61 USD/QALY.This was substantially lower than the gross domestic product (GDP) per capita for India (1489 USD), suggesting the NIV strategy was very cost effective.Using a 5% discount rate resulted in only minimally different results.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, Michigan, USA.

ABSTRACT

Introduction: The majority of Indian hospitals do not provide intensive care unit (ICU) care or ward-based noninvasive positive pressure ventilation (NIV). Because no mechanical ventilation or NIV is available in these hospitals, the majority of patients suffering from respiratory failure die.

Objective: To perform a cost-effective analysis of two strategies (ward-based NIV with concurrent standard treatment vs standard treatment alone) in chronic obstructive pulmonary disease (COPD) respiratory failure patients treated in Indian hospitals without ICU care.

Materials and methods: A decision-analytical model was created to compare the cost-effectiveness for the two strategies. Estimates from the literature were used for parameters in the model. Future costs were discounted at 3%. All costs were reported in USD (2012). One-way, two-way, and probabilistic sensitivity analysis were performed. The time horizon was lifetime and perspective was societal.

Results: The NIV strategy resulted in 17.7% more survival and was slightly more costly (increased cost of $101 (USD 2012) but resulted in increased quality-adjusted life-years (QALYs) (1.67 QALY). The cost-effectiveness (2012 USD)/QALY in the standard and NIV groups was $78/QALY ($535.02/6.82) and $75/QALY ($636.33/8.49), respectively. Incremental cost-effectiveness ratio (ICER) was only $61 USD/QALY. This was substantially lower than the gross domestic product (GDP) per capita for India (1489 USD), suggesting the NIV strategy was very cost effective. Using a 5% discount rate resulted in only minimally different results. Probabilistic analysis suggests that NIV strategy was preferred 100% of the time when willingness to pay was >$250 2012 USD.

Conclusion: Ward-based NIV treatment is cost-effective in India, and may increase survival of patients with COPD respiratory failure when ICU is not available.

No MeSH data available.


Related in: MedlinePlus