Noninvasive Ventilation at Home Lowers Mortality and Health Care Costs in Hypercapnic COPD-CRF

As noninvasive ventilation at home (NIVH) is gaining more acceptance as a viable treatment option for patients with chronic obstructive pulmonary disease with chronic respiratory failure (COPD-CRF), it is still uncertain what the optimal initiation time for NIVH is and whether NIVH is more effective for certain COPD-CRF phenotypes. Therefore, researchers aimed to investigate how the timing of starting NIVH affected mortality, hospitalization, emergency department (ED) visits, and health care costs for patients with different COPD-CRF phenotypes.

Published in Respiratory Medicine, study results suggest that the sooner NIVH is started after diagnosis, the greater the reductions in mortality risk, hospitalizations, ED visits, and Medicare costs for patients with hypercapnic COPD-CRF. No benefit of NIVH on patients with hypoxic or unspecific COPD-CRF was found.

Data used in this observational, retrospective, cohort study were from 100% research identifiable fee-for-service Medicare claims collected from 2016 to 2020. The study included 499,717 Medicare beneficiaries diagnosed with COPD and CRF during January 2016 to December 2019.

The treatment group was comprised of 6707 (1.3%) patients who received NIVH 2 months of being diagnosed with COPD-CRF. Researchers assigned the treatment group to 4 different time windows based on when they started NIVH: 0-7 days, 8-15 days, 16-30 days, or 31-60 days after diagnosis.

The control group included 493,010 (98.7%) patients who did not receive NIVH. Researchers further divided all patients in both the treatment and control groups by assigning them to 3 different COPD-CRF phenotypes: COPD-CRF unspecified, COPD-CRF with hypoxia, and COPD-CRF with hypercapnia.

Overall, NIVH was significantly correlated with improved survival rates in the full sample and for patients with hypercapnic COPD-CRF. However, the effectiveness of NIVH in reducing risk of death decreased as the time between diagnosis and starting NIVH increased for both the full sample and patients with hypercapnic COPD-CRF.

For patients with hypercapnic COPD-CRF, risk of death was significantly reduced by 43% for those who started NIVH 0-7 days after diagnosis, 31% for those who started 8-15 days after diagnosis, and 16% of those who started 16-30 days after diagnosis. These data suggest that the earlier a patient with hypercapnic COPD-CRD starts NIVH after diagnosis, the lower their risk of death, the researchers noted.

NIVH initiated 0-30 days after diagnosis significantly reduced the risk of hospitalization for patients with hypercapnic COPD-CRF by approximately 23%. NIVH also significantly reduced the risk of emergency department (ED) visits for patients with hypercapnic COPD-CRF who began treatment 0-30 days after diagnosis, but not in the 0-7 or 0-15-day windows.

NIVH did not significantly reduce risk of death, risk of hospitalization, or risk of ED visits for patients with hypoxic or unspecified COPD-CRF. Instead, patients with hypoxic COPD-CRF who started NIVH 16-30 days after diagnosis had a significantly increased risk of death.

Medicare spending in the year following diagnosis was correlated with the time of starting NIVH for patients with hypercapnic COPD-CRF. Starting NIVH 0-7 days and 0-15 days after diagnosis resulted in a $5484 and $3412 reduction in Medicare spending respectively over the following year. These results suggest that the sooner a patient with hypercapnic COPD-CRF starts NIVH after diagnosis, the greater their healthcare cost savings, the researchers noted.

For patients with hypoxic COPD-CRF, use of NVIH significantly increased Medicare spending in the year after diagnosis. For patients with unspecified COPD-CRF, NIVH initiated 8-15 days after diagnosis resulted in a reduced Medicare spending, but if initiated in any other time window, increases in spending were observed.

Limitations of this study include the retrospective, non-randomized design. In addition, because the Medicare 100% RIF claims does not include data from non-fee-for-service populations, the results of this study cannot be generalized to these populations.

This study is the first to show an association between early initiation of NIVH and significant reductions in mortality, hospitalizations, and Medicare costs for patients with hypercapnic COPD-CRF, the authors said.

Reference

Frazier WD, DaVanzo JE, Dobson A, Heath S, Mati K. Early initiation of non-invasive ventilation at home improves survival and reduces healthcare costs in COPD patients with chronic hypercapnic respiratory failure: a retrospective cohort study. Respir Med. 2022;200. doi:10.1016/j.rmed.2022.106920