Limits...
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

Two-way sensitivity analysis for probability of death in the NIV group and the standard treatment group.pDieNIV = Probability of death in NIV group, pDieStd = Probability of death in standard treatment group, WTP = Willingness to pay
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Two-way sensitivity analysis for probability of death in the NIV group and the standard treatment group.pDieNIV = Probability of death in NIV group, pDieStd = Probability of death in standard treatment group, WTP = Willingness to pay

Mentions: A two-way sensitivity analysis varying the probability of death in both groups at the same time (while holding all other variables constant) is shown in Figure 4. Notably, the range of the NIV strategy was preferred throughout the entire range of the standard treatment probabilities. However, to determine what death probabilities would cause the standard treatment strategy to be preferred, the ranges for possible death were made equivalent. When this was done, it was clear that the strategy preferred was always the NIV strategy until the death rate in the NIV group was equal to the death rate in the standard treatment [Figure 4]. As all studies conducted to date have found a decreased intubation rate (which is the marker for death in this model that assumes no ICU facilities available so that those needing intubation would die) in the NIV group, this again supports the NIV treatment. Additionally, this is intuitive as the cost of NIV treatment is more than the cost of standard treatment; hence, when the mortality rates become equal, it would be the point that would make the standard treatment more cost-effective (same probability of death but less expensive).


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)

Two-way sensitivity analysis for probability of death in the NIV group and the standard treatment group.pDieNIV = Probability of death in NIV group, pDieStd = Probability of death in standard treatment group, WTP = Willingness to pay
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Two-way sensitivity analysis for probability of death in the NIV group and the standard treatment group.pDieNIV = Probability of death in NIV group, pDieStd = Probability of death in standard treatment group, WTP = Willingness to pay
Mentions: A two-way sensitivity analysis varying the probability of death in both groups at the same time (while holding all other variables constant) is shown in Figure 4. Notably, the range of the NIV strategy was preferred throughout the entire range of the standard treatment probabilities. However, to determine what death probabilities would cause the standard treatment strategy to be preferred, the ranges for possible death were made equivalent. When this was done, it was clear that the strategy preferred was always the NIV strategy until the death rate in the NIV group was equal to the death rate in the standard treatment [Figure 4]. As all studies conducted to date have found a decreased intubation rate (which is the marker for death in this model that assumes no ICU facilities available so that those needing intubation would die) in the NIV group, this again supports the NIV treatment. Additionally, this is intuitive as the cost of NIV treatment is more than the cost of standard treatment; hence, when the mortality rates become equal, it would be the point that would make the standard treatment more cost-effective (same probability of death but less expensive).

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