Cost-utility analysis of home mechanical ventilation compared to hospital settings in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a chronic inflammatory disease that can be prevented and treated. The goals of therapy are to relieve symptoms, prevent disease progression, prevent exacerbations, improve general condition and physical performance, and reduce mortality. Mechanical ventilation is part of the standard treatment and can currently also be provided in the home environment. The aim of the study is to analyse the cost-effectiveness of home mechanical ventilation in adult patients with chronic obstructive pulmonary disease compared to facility-based mechanical ventilation from the perspective of a health care payer in the Czech Republic. A Markov model was used for the evaluation and its input parameters were obtained from the literature review and from the opinions of experts from home care and home mechanical ventilation companies. The cost-utility analysis was carried out over a time horizon of 10 years, including sensitivity analyses and multiple scenario analyses. The cumulative costs per person of home mechanical ventilation are CZK 2,378,660 and the cumulative costs per person of the facility-based mechanical ventilation are CZK 5,793,883. The cumulative utilities per person of home mechanical ventilation are 1.20 QALY and the cumulative utilities per person of facility-based mechanical ventilation are 1.16 QALY. The incremental cost-utility ratio is -73,131,881 CZK/QALY. Sensitivity analyses and multiple scenario analyses showed no changes. Home mechanical ventilation was shown to be cost-effective for patients with chronic obstructive pulmonary disease, because it strongly dominates mechanical ventilation in a health care facility.