ReviewCost-utility of non-invasive mechanical ventilation: Analysis and implications in acute respiratory failure. A brief narrative review
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
References (72)
- et al.
Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease
Lancet
(1993) - et al.
Human and financial costs of noninvasive mechanical ventilation in patients affected by COPD and acute respiratory failure
Chest
(1997) - et al.
Non-invasive ventilation in acute respiratory failure
Lancet
(2009) - et al.
Early use on non-invasive ventilation for acute exacerbations of chronic pulmonary obstructive disease on general respiratory wards: a multicentre randomised controlled trial
Lancet
(2000) - et al.
Non invasive mechanical ventilation in acute respiratory failure: rationale and current applications
Sleep Med Clin
(2017) - et al.
Financial implications of noninvasive positive pressure ventilation (NPPV)
Chest
(1995) - et al.
The noninvasive respiratory care unit. Patterns of use and financial implications
Chest
(1991) - et al.
Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses
Chest
(1991) - et al.
Noninvasive nasal mask ventilation for acute respiratory failure. Institution of a new therapeutic technology for routine use
Chest
(1994) - et al.
Costs of the COPD. Differences between intensive care unit and respiratory intermediate care unit
Respir Med
(2005)
Non invasive positive pressure ventilation via face mask first line intervention in patients with acute hypercapnic and hypoxemic respiratory failure
Chest
Cost savings from reduced hospitalizations with use of home noninvasive ventilation for COPD
Value Health
How to initiate a noninvasive ventilation program: bringing the evidence to the bedside
Respir Care
Noninvasive ventilation in the acute care hospital: a cost factor?
Med Klin (Munich)
Economic analysis in admitted patients with acute exacerbation of chronic obstructive pulmonary disease
Chin Med J (Engl)
Noninvasive ventilation in acute respiratory failure
Int J COPD
Predicting survival after acute exacerbation chronic obstructive pulmonary disease (ACOPD) iss long term application of noninvasive ventilation the last life guard?
Int J COPD
Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: cochrane systematic review and meta-analysis
Br Med J
Noninvasive ventilation: practical advice
Curr Opin Crit Care
Acute ventilator failure complicating obesity hypoventilation: update on a “critical care syndrome”
Curr Opin Pulm Med
Noninvasive positive pressure ventilation for patients with terminal respiratory failure: the ethical and economic costs of delaying the inevitable are too great
Am J Crit Care
Cost/benefit of noninvasive mechanical ventilation
Monaldi Arch Chest Dis
Non-invasive ventilation (NIV) in the clinical management of acute COPD in 233 UK hospitals: results from the RCP/BTS 2003
Natl COPD Audit COPD
Noninvasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease: more effective and less expensive
Crit Care Med
How to enhance experience and skill of non invasive ventilation: suggestions from the literature
Shortness Breath
Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial
Br Med J
Prehospital non-invasive ventilation for acute cardiogenic pulmonary oedema: an evidence-based review
Emerg Med J
Evaluation of the effect of prehospital application of continuous positive airway pressure therapy in acute respiratory distress
Prehosp Disarter Med
Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation
Health Technol Assess
Prehospital noninvasive ventilation for acute respiratory failure: systematic review, network meta-analysis and individual patient data meta-analysis
Acad Emerg Med
Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure: a systematic review of controlled studies
Trauma Resusc Emerg Med
Estimates of cost-effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema
Prehosp Emerg Care
Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial
Br Med J
Non invasive positive pressure ventilation for acute respiratory failure patients due to exacerbations of chronic obstructive pulmonary disease
Ont Health Technol Assess Ser
Cost effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospital without ICU facilities
Lung India
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