Home non-invasive ventilation reduces hospitalizations, and healthcare costs in adult patients with severe chronic obstructive pulmonary disease

Chronic hypercapnic respiratory failure decreases both life quality and expectancy in patients with severe chronic obstructive pulmonary disease. Home non-invasive ventilation (HNIV) support might be an effective option to improve their unfavourable prognosis. This retrospective cohort study used data from six Czech health insurance companies (covering 44% of the population) from 2017 to 2022. It included patients ≥ 18 years with COPD and chronic respiratory failure hospitalized during the study period. Exclusion criteria were dementia, prior HNIV treatment, death in 90 days after hospital discharge. Patients were divided into HNIV treatment and control groups. Propensity score matching was used to balance treatment groups. Mortality was assessed using Cox proportional hazards models, and hospitalization counts were analyzed using negative binomial regression accounting for individual follow-up time. The study analyzed 867 patients, with 396 meeting the inclusion criteria. After propensity score matching, the first selection included 192 patients (64 HNIV, 128 comparators), and the second selection included 144 patients (48 early HNIV, 96 comparators). HNIV was associated with a significantly lower risk of death (adjusted HR = 0.55; 95% CI, 0.31–0.99; p = 0.046). Two-year Kaplan–Meier mortality was 24.0% with HNIV versus 34.7% without HNIV. Although the unadjusted annualized hospitalization rate was lower with HNIV, the adjusted difference in admission counts was not statistically significant (IRR for comparators vs. HNIV = 1.50; 95% CI, 0.94–2.40; p = 0.087), while inpatient days were significantly lower with HNIV. Early HNIV was also associated with lower mortality (adjusted HR = 0.43; 95% CI, 0.21–0.86). HNIV was associated with lower mortality and fewer inpatient days in patients with severe COPD and chronic respiratory failure. Hospitalization costs were lower in the HNIV groups, although the differences were not statistically significant.