Cost-utility Analysis of Home Mechanical Ventilation Compared to Hospital Settings in Patients with Amyotrophic Lateral Sclerosis

Abstract

Abstract Amyotrophic lateral sclerosis is a progressive neuromuscular disease. Mechanical ventilation delays death and use at home can reduce costs and increase quality of life. The aim of the study is comparison of home mechanical ventilation with mechanical ventilation in a healthcare facility for adult patients with amyotrophic lateral sclerosis from the societal perspective in the Czech Republic. The Markov model from a previous Czech study was used and updated with data revelant to the societal perspective, which was obtained from the literature and opinions of experts from companies dealing with home mechanical ventilation. The cost-utility analysis was carried out over a time horizont of 10 years and results were presented in incremental cost-utility ratio. Accuracy and validity were verified by probabilistic sensitivity analysis and scenario analysis. The cumulative costs of home mechanical ventilation are CZK 6,116,394 and the cumulative utilities of home mechanical ventilation are CZK 8,195,848. The cumulative utilities of home mechanical ventilation are 3.55 QALY and the cumulative utilities of mechanical ventilation are 3.78 QALY. The incremental cost-utility ratio is CZK 9,094,042. Probabilistic sensitivity analysis and scenario analysis do not show significant changes. Home mechanical ventilation may be considered cost-effective for patients with amyotrophic lateral sclerosis from the societal perspective.