Abstract
Amyotrophic lateral sclerosis is a disease with rapid progression. The use of mechanical ventilation helps to manage symptoms and delays death. Use in a home environment could reduce costs and increase quality of life. The aim of this study is a cost–utility analysis of home mechanical ventilation in adult patients with amyotrophic lateral sclerosis from the perspective of healthcare payers in the Czech Republic. The study evaluates home mechanical ventilation (HMV) and mechanical ventilation (MV) in a healthcare facility. A Markov model was compiled for evaluation in a timeframe of 10 years. Model parameters were obtained from the literature and opinions of experts from companies dealing with home care and home mechanical ventilation. The cost–utility analysis was carried out at the end of the study and results are presented in incremental cost–utility ratio (ICUR) using quality-adjusted life-years. Uncertainty was assessed by one-way sensitivity analysis and scenario analysis. The cumulative costs of HMV are CZK 1,877,076 and the cumulative costs of the MV are CZK 7,386,629. The cumulative utilities of HMV are 12.57 quality-adjusted life year (QALY) and the cumulative utilities of MV are 11.32 QALY. The ICUR value is CZK-4,403,259. The results of this study suggest that HMV is cost effective.
Highlights
Amyotrophic lateral sclerosis (ALS) is a condition characterized by degeneration of lower and upper motor neurons resulting in progressive weakness of skeletal muscles including the muscles used for breathing
The cohort of patients in the Markov model was distributed within individual cyc The cohort of patients in the Markov model was distributed within individual cycles depending on on thethe selected probabilities inmodel
10-year timespan is presented in the follo cohort in individualhealth health states the the
Summary
Amyotrophic lateral sclerosis (ALS) is a condition characterized by degeneration of lower and upper motor neurons resulting in progressive weakness of skeletal muscles including the muscles used for breathing. This condition is rapidly progressive and, on average, within 2 to 4 years from the onset of symptoms, the failure of breathing functions due to respiratory muscle damage becomes a frequent cause of death. There is still no existing treatment for this disease, various stages of the disease are still being studied, so some types of treatment including mechanical ventilation may help to relieve symptoms and delay death [1,2,3,4]. In ALS, both non-invasive and invasive mechanical ventilation is being employed.
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