Hospital Cost Savings for Sequential COPD Patients Receiving Domiciliary Nasal High Flow Therapy

• Published in: International journal of chronic obstructive pulmonary disease Vol. 17; pp. 1311 - 1322
• Main Authors: Milne, Richard J, Hockey, Hans-Ulrich, Garrett, Jeffrey
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2022; Dove Medical Press Ltd; Dove; Dove Medical Press
• Subjects: Ambulatory care; Analysis; budget impact; Capital costs; Chronic illnesses; Chronic obstructive pulmonary disease; Clinical trials; copd; cost; Cost control; Denmark; hospital admissions; Hospital costs; Hospitals; Length of stay; long term oxygen therapy (ltot); Lung diseases, Obstructive; Medical care, Cost of; Medical records; Medical research; Medicine, Experimental; nasal high flow; New Zealand; Original Research; Oxygen therapy; Patient admissions; Quality of life; Questionnaires; Severe acute respiratory syndrome coronavirus 2; Ventilators; Workforce planning; New Zealand; Denmark; New Zealand; cost; hospital admissions; long term oxygen therapy; nasal high flow; budget impact; LTOT; COPD
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S350267

To estimate the 5-year budget impact to Aotearoa New Zealand (NZ) hospitals of domiciliary nasal high flow (NHF) therapy to patients with chronic obstructive pulmonary disease (COPD) who require long term oxygen therapy. Hospital admission counts along with length of stay were obtained from hospital records of 200 COPD patients enrolled in a 12-month randomized clinical trial of NHF in Denmark, both over a 12-month baseline and then in the study period while on randomized treatment (control or NHF). NZ costings from similar COPD patients were estimated using data from Middlemore Hospital, Auckland and were applied to the Danish trial. The budget impact of NHF was estimated over the predicted 5-year lifetime of the device when used by patients sequentially. Fifty-five of 100 patients in the NHF group and 44 of 100 patients in the control group were admitted to hospital with a respiratory diagnosis during the baseline year. They had 108 admissions in the treatment group vs 89 in the control group, with 632 vs 438 days in hospital, and modeled annual costs of $9443 vs $6512 per patient, respectively. During the study period there were 38 vs 44 patients with 67 vs 80 admissions and 302 vs 526 days in hospital, at a modeled annual cost of $6961 vs $9565 per patient respectively. Taking into account capital expenditure and running costs, this resulted in cost savings of $5535 per patient-year (95% CI, -$36 to -$11,034). With 90% usage over the estimated five-year lifetime of the NHF device, amortized capital costs of $594 per year and annual running costs of $662, we estimate a 5-year undiscounted cost saving per NHF device of $18,626 ($16,934 when discounted to net present value at 5% per annum). There would still be annual cost savings over a wide range of assumptions. Domiciliary NHF therapy for patients with severe COPD has the potential to provide substantial hospital cost savings over the five-year lifetime of the NHF device.