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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

Results of one-way sensitivity analysis on incremental cost-effectiveness ratio. (ICER) for all variables. QALY = QALY after hospitalization, DStdLive = Days of standard treatment in survivors, cDayWrd = Cost of day on ward, cDayNivWrd = Cost of NIV treatment on ward per day, cCOPDyr = Cost of health care for COPD per year, TotaDayNIV = Total LOS in days of NIV treatment in survivors, DaysStdDie = Days of standard treatment before death, DaysNIVDie = Days of NIV treatment before death, pDieNIV = Probability of death in the NIV group
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Figure 2: Results of one-way sensitivity analysis on incremental cost-effectiveness ratio. (ICER) for all variables. QALY = QALY after hospitalization, DStdLive = Days of standard treatment in survivors, cDayWrd = Cost of day on ward, cDayNivWrd = Cost of NIV treatment on ward per day, cCOPDyr = Cost of health care for COPD per year, TotaDayNIV = Total LOS in days of NIV treatment in survivors, DaysStdDie = Days of standard treatment before death, DaysNIVDie = Days of NIV treatment before death, pDieNIV = Probability of death in the NIV group

Mentions: Results of the one-way sensitivity analysis on ICER are revealed in Figure 2. This tornado diagram reveals one-way sensitivity of all of the relevant variables. It represents how the expected value for the ICER would vary as each variable was processed through its range of possibilities (while all other variables were held constant). Notably, ICER remains very low and is always positive (implying that through the range of values for each variable, the NIV strategy is always cost-effective). Figure 3 reveals the results of the cost-effectiveness analysis displaying the increased cost but also increased effectiveness in the NIV strategy.


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)

Results of one-way sensitivity analysis on incremental cost-effectiveness ratio. (ICER) for all variables. QALY = QALY after hospitalization, DStdLive = Days of standard treatment in survivors, cDayWrd = Cost of day on ward, cDayNivWrd = Cost of NIV treatment on ward per day, cCOPDyr = Cost of health care for COPD per year, TotaDayNIV = Total LOS in days of NIV treatment in survivors, DaysStdDie = Days of standard treatment before death, DaysNIVDie = Days of NIV treatment before death, pDieNIV = Probability of death in the NIV group
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Results of one-way sensitivity analysis on incremental cost-effectiveness ratio. (ICER) for all variables. QALY = QALY after hospitalization, DStdLive = Days of standard treatment in survivors, cDayWrd = Cost of day on ward, cDayNivWrd = Cost of NIV treatment on ward per day, cCOPDyr = Cost of health care for COPD per year, TotaDayNIV = Total LOS in days of NIV treatment in survivors, DaysStdDie = Days of standard treatment before death, DaysNIVDie = Days of NIV treatment before death, pDieNIV = Probability of death in the NIV group
Mentions: Results of the one-way sensitivity analysis on ICER are revealed in Figure 2. This tornado diagram reveals one-way sensitivity of all of the relevant variables. It represents how the expected value for the ICER would vary as each variable was processed through its range of possibilities (while all other variables were held constant). Notably, ICER remains very low and is always positive (implying that through the range of values for each variable, the NIV strategy is always cost-effective). Figure 3 reveals the results of the cost-effectiveness analysis displaying the increased cost but also increased effectiveness in the NIV strategy.

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