Groessl Erik J, Tally Steven R, Hillery Naomi
Health Services Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA.
VA San Diego Healthcare System, San Diego, CA, USA.
Clinicoecon Outcomes Res. 2023 Apr 5;15:239-250. doi: 10.2147/CEOR.S400739. eCollection 2023.
Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality, and is associated with significant respiratory impairment, decreased quality of life, and high health care costs. Recent evidence indicates significant clinical benefit results from adding humidified high-flow therapy (HHFT) to standard long-term oxygen therapy (LTOT) as a home-based therapy in persons with severe COPD. The objective was to evaluate the cost-effectiveness of adding HHFT to standard treatment of COPD patients using LTOT with US healthcare cost estimates.
A Markov state-transition model was developed using data from a prospective clinical trial of adding HHFT to standard therapy for persons with severe COPD using LTOT. The analysis was conducted from the US health care system perspective using a 5-year time horizon and 3% discount rate. QALYs and downstream healthcare costs were modeled. One-way and probabilistic sensitivity analyses were used to examine the impact of input parameters on the incremental net monetary benefit (NMB).
Incremental QALYs accrued were 0.058 (2.047 vs 1.989 QALYs for HHFT and standard therapy groups respectively). Incremental total costs were -$3939 ($47,516 vs $51,455 for HHFT and standard therapy groups respectively). Thus, HHFT was the dominant treatment in the analysis, resulting on both better health and lower total costs. Varying utility and cost inputs individually never resulted in NMB approaching 0. Probabilistic analyses indicate that HHFT is cost-effective in 84% of simulations.
Our results indicate that the reductions in acute exacerbations of COPD (AECOPDs) that result from adding HHFT for persons with COPD on LTOT will produce both health benefit (QALYs) and cost savings. Cost savings occur because the HHFT device costs are more than offset by reductions in costly COPD exacerbations. Health care systems and payors can benefit from wider implementation of HHFT with existing treatments.
慢性阻塞性肺疾病（COPD）是第三大致死原因，与严重的呼吸功能损害、生活质量下降及高昂的医疗费用相关。近期证据表明，在重度COPD患者中，作为家庭治疗方法，在标准长期氧疗（LTOT）基础上加用湿化高流量疗法（HHFT）可带来显著的临床益处。目的是使用美国医疗成本估算评估在COPD患者的标准治疗中加用HHFT的成本效益。
利用一项前瞻性临床试验的数据建立了马尔可夫状态转换模型，该试验是在使用LTOT的重度COPD患者的标准治疗基础上加用HHFT。从美国医疗系统的角度进行分析，时间跨度为5年，贴现率为3%。对质量调整生命年（QALYs）和下游医疗成本进行建模。采用单向和概率敏感性分析来检验输入参数对增量净货币效益（NMB）的影响。
累积的增量QALYs为0.058（HHFT组和标准治疗组分别为2.047和1.989 QALYs）。增量总成本为 - 3939美元（HHFT组和标准治疗组分别为47,516美元和51,455美元）。因此，在分析中HHFT是占优治疗方法，带来了更好的健康状况和更低的总成本。单独改变效用和成本输入从未使NMB接近0。概率分析表明，在84%的模拟中HHFT具有成本效益。
我们的结果表明，在使用LTOT的COPD患者中加用HHFT可减少慢性阻塞性肺疾病急性加重（AECOPDs），这将带来健康益处（QALYs）并节省成本。成本节省的原因是HHFT设备成本被昂贵的COPD加重的减少所抵消。医疗系统和支付方可以通过在现有治疗中更广泛地实施HHFT而受益。
