Review
Cost-utility of non-invasive mechanical ventilation: Analysis and implications in acute respiratory failure. A brief narrative review

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Abstract

The growing interest in the quality of patient care at the levels of the health care managers, insurance companies, and health professionals is evident. Further, the growing population requires good quality health services. In this review, we analyzed the cost-effectiveness of noninvasive ventilation (NIV) in an acute setting for the treatment of respiratory failure. The strength of this review is that it identified and summarized the most relevant studies regarding various aspects of the cost-utility of NIV in an acute setting. This is the first review that focuses on the importance of the skills and training of the team in the reduction of costs associated with NIV. However, the small number of studies, heterogeneity of quality, and different outcomes of the different studies are the greatest limitations of this review. In conclusion, although there is great variation in the data drawn from the literature, NIV seems to be a cost-effective tool, especially in specific patients (those with chronic obstructive pulmonary disease) for whom the addition of NIV improves outcomes and has a positive impact on this expenditure.

Introduction

The growing interest in the quality of patient care at the levels of health care managers, insurance companies, and health professionals is evident. The growing population requires good quality health care and cost-efficient treatment [1], [2]. However, managers and insurance companies are more concerned about health care expenditures and question the purpose of the money spent on health care services and the cost of health care [3], [4]. Finally, health care professionals have always been, at least implicitly, concerned with the quality of care they can provide to their patients with the best available treatment options, as well as the ethics related to the following three fundamental points: 1) to meet the patient's expectations; 2) to be consistent with the inherent scientific commitment and to practice evidence-based medicine; and 3) the responsibility of maintaining professional competence. These aspects are of interest to those in the respiratory intensive care field where the introduction of less invasive airway management devices, such as noninvasive ventilation (NIV), as alternatives to intubation has led to lower mortality and intubation rates compared to those observed with the standard medical treatment [1], [2], [3].The available evidence suggests that for optimum success, the multidisciplinary nature of the implementation of NIV must be recognized. The NIV program should be a quality-improvement initiative. Following these principles, a successful program can be initiated in any acute care setting [2]. The aim of this review is to evaluate the clinical effectiveness and cost-effectiveness of NIV in an acute setting.

Section snippets

Methods

Database searches included a MEDLINE and other relevant databases based on a systematic literature search from 1990 to 2017 of the current literature, randomized controlled studies, systematic reviews, and health technology assessment (HAT) reports, clinical studies, health-economic evaluations, primary studies with cost analyses, and quality-of-life studies related to the research questions.

Results of pre-hospital applications

Several studies evaluated the use of pre-hospital NIV for ARF [25], [26], [27]. Continuous positive airway pressure (CPAP) in the pre-hospital setting is beneficial for patients in acute respiratory distress [28], [29]. In a recent review, Goodacre et al. analyzed the studies regarding the use of NIV in a pre-hospital setting. The studies were published from 2000 to 2012. Six studies enrolled patients with ACPE and one patient with COPD exacerbations [28]. Six of them were evaluated on CPAP and

Discussion

Few studies that investigate the cost-effectiveness of NIV for ARF are available. Most are focused on COPD [6], [18], [19], [20], [30], [33], [36] and the rest on pre-hospital NIV for ARF [27], [31]. Contrary to the studies evaluating cost-effectiveness of home NIV [68], [69], [70], those evaluating NIV in ARF are characterized by a great methodological inhomogeneity and are difficult to compare. Although these limitations NIV can be considered a strategy of cost-effectiveness, especially in a

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