BMJ 2003;326:956 ( 3 May )

Papers

Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial

P K Plant, consultant physician in respiratory medicine, ^a J L Owen, respiratory nurse specialist, ^a S Parrott, lecturer in halth economics, ^b M W Elliott, consultant in respiratory medicine. ^a

^a Department of Respiratory Medicine, St James's University Hospital, Leeds LS9 7TF, ^b Centre for Health Economics, University of York, York YO10 5DD

Correspondence to: P K Plant
paul.plant{at}leedsth.nhs.uk

Objective: To evaluate the cost effectiveness of standard treatment with and without the addition of ward based non-invasive ventilation in patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease.
Design: Incremental cost effectiveness analysis of a randomised controlled trial.
Setting: Medical wards in 14 hospitals in the United Kingdom.
Participants: The trial comprised 236 patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease and mild to moderate acidosis (pH 7.25-7.35) secondary to respiratory failure. The economic analysis compared the costs of treatment that these patients received after randomisation.
Main outcome measure: Incremental cost per in-hospital death.
Results: 24/118 died in the group receiving standard treatment and 12/118 in the group receiving non-invasive ventilation (P=0.05). Allocation to the group receiving non-invasive ventilation was associated with a reduction in costs of £49 362 ($78 741; 73 109), mainly through reduced use of intensive care units. The incremental cost effectiveness ratio was £645 per death avoided (95% confidence interval £2310 to £386), indicating a dominant (more effective and less costly) strategy. Modelling of these data indicates that a typical UK hospital providing a non-invasive ventilation service will avoid six deaths and three to nine admissions to intensive care units per year, with an associated cost reduction of £12 000-53 000 per year.
Conclusions: Non-invasive ventilation is a highly cost effective treatment that both reduced total costs and improved mortality in hospital.

What is already known on this topic Non-invasive ventilation reduces the need for intubation and mortality in hospital in patients with acute exacerbations of chronic obstructive pulmonary disease and acute respiratory failure The procedure is feasible in the ward or intensive care environment What this study adds Non-invasive ventilation given on wards reduces the need for intubation by 44% and halves mortality in hospital in patients with chronic obstructive pulmonary disease and mild to moderate acidosis The early use of non-invasive ventilation on the ward reduces costs and improves outcomes compared with traditional medical treatment The main cost saving is in preventing the use of intensive care facilities

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