Clini Enrico M, Magni Giovanna, Crisafulli Ernesto, Viaggi Stefano, Ambrosino Nicolino
Department of Oncology, Hematology and Pneumology, University of Modena, Ospedale Villa Pineta, Via Gaiato 127, Pavullo n/F, Italy.
Respiration. 2009;77(1):44-50. doi: 10.1159/000127410. Epub 2008 Apr 16.
A cost analysis of nocturnal non-invasive ventilation (NNV) in stable chronic obstructive pulmonary disease (COPD) patients would be helpful in decision making, when the balance between the increased demand and the availability of resources should be checked.
Based on data from the Italian trial in stable hypercapnic COPD patients, this study compares the cost of care associated with the use of NNV when added to the usual long-term oxygen therapy (LTOT) with the cost of care of LTOT regimen alone.
Cost was calculated in 77 of 90 patients included into that trial. Analysis included drug therapy, hospitalisations due to acute exacerbation, oxygen and ventilator equipment. An estimation of charges was made according to the national sources of cost for drugs and hospital admissions and the actualised reimbursement for the home care provided to both oxygen and ventilator users. The cost/day comparison was made between the individual patients in the 2 groups (NNV + LTOT, n = 35; LTOT, n = 42).
The mean cost of drugs and oxygen was similar in both groups, whereas the cost of hospitalisation tended to be lower in NNV + LTOT compared to LTOT alone (8.25 +/-10.29 vs. 12.50 +/- 20.28 EUR/patient/day, p < 0.05). Inclusion of the ventilator equipment increased the total cost to 23.73 EUR/day in the NNV + LTOT compared to 21.42 EUR/day in the LTOT group (not significant).
The present report suggests that long-term management with addition of non-invasive ventilation does not increase costs compared with the usual LTOT regimen: the hospital-related costs were reduced when using the ventilator in these hypercapnic COPD patients.
对于病情稳定的慢性阻塞性肺疾病（COPD）患者，进行夜间无创通气（NNV）的成本分析有助于决策，此时需要权衡需求增加与资源可用性之间的平衡。
基于意大利针对病情稳定的高碳酸血症COPD患者的试验数据，本研究比较了在常规长期氧疗（LTOT）基础上加用NNV的护理成本与单纯LTOT方案的护理成本。
在该试验纳入的90例患者中的77例中计算成本。分析包括药物治疗、急性加重导致的住院、氧气和呼吸机设备。根据国家药物和住院费用来源以及向氧气和呼吸机使用者提供的家庭护理的实际报销情况进行费用估算。对两组个体患者（NNV + LTOT，n = 35；LTOT，n = 42）进行每日成本比较。
两组的药物和氧气平均成本相似，而与单纯LTOT相比，NNV + LTOT组的住院成本往往更低（8.25 +/- 10.29 vs. 12.50 +/- 20.28欧元/患者/天，p < 0.05）。与LTOT组的21.42欧元/天相比，NNV + LTOT组中纳入呼吸机设备使总成本增加至23.73欧元/天（无显著差异）。
本报告表明，与常规LTOT方案相比，加用无创通气的长期管理不会增加成本：在这些高碳酸血症COPD患者中使用呼吸机时，与医院相关的成本有所降低。
