IMPACT OF NON-INVASIVE VENTILATION ON HEALTH COSTS AND OUTCOMES

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Patients with chronic respiratory failure resulting from chronic obstructive pulmonary disease (COPD-CRF) have limited treatment options and poor health outcomes. We sought to understand the impact of non-invasive ventilation at home (NIVH) on mortality, hospitalization rates, and emergency room (ER) visits for this population. METHODS: We performed a retrospective cohort study using the Medicare Limited Data Set. We included patients who had a diagnosis of both CRF and COPD made between 2012 and 2016. Patients were divided into a treatment group identified by receipt of NIVH within two months of initial CRF diagnosis, and a control group defined by absence of NIVH use. We used “doubly robust” methods to mitigate confounding/selection bias. We first estimated the propensity score for treatment receipt and weighted the sample using stabilized inverse probability of treatment weights (IPTW). We then applied Cox survival models with regression controls to the reweighted samples to estimate the impact of NIVH on patient outcomes. To account for violation of the Cox proportional hazard assumption, we adjusted our models to permit estimated hazard ratios (HRs) to be time-varying. Because of the two-part modeling design, bootstrap methods were used to calculate standard errors. Primary study outcomes were all-cause mortality, hospitalization rates, and emergency room (ER) utilization. RESULTS: We identified 410 COPD-CRF patients treated with NIVH (treatment group), and 36,604 COPD-CRF patients not treated with NIVH (control group). The IPTW weighting procedure achieved good balance between the treatment and control groups in both baseline demographic characteristics and in indices of disease severity. The estimated HR for all-cause mortality was 0.616 (95% CI 0.486-0.788), indicating that NIVH was associated with a 38% reduction in risk of death for newly diagnosed COPD-CRF patients. NIVH was also associated with a reduced risk of hospitalization (HR 0.699, 95% CI, 0.588-0.833 indicating a 30% reduction in hospital admissions. Likewise ER visits were reduced in the NIVH group (HR 0.545, 95% CI, 0.471-0.641) indicating a 45% reduction in ER use. The HRs for all-cause mortality and ER utilization were both associated with a statistically significant decay parameter of 1.001, indicating a gradual decline in NIVH benefit over time. The HR for hospitalization benefit was estimated to be stable over time. CONCLUSIONS: COPD-CRF patients who are prescribed NIVH have a statistically significant and clinically meaningful reduction in the risk of death, hospitalization, and ER visits compared to similar patients not treated with NIVH. CLINICAL IMPLICATIONS: Physicians caring for COPD-CRF patients should consider prescribing NIVH treatment to reduce patient mortality, hospitalization rates, and ER visits. DISCLOSURES: Board Member relationship with Viemed Please note: $20001 - $100000 Added 06/11/2019 by William Frazier, source=Web Response, value=Salary Chief Medical Officer relationship with Viemed Please note: >$100000 Added 06/11/2019 by William Frazier, source=Web Response, value=Salary Consultant relationship with Precision Health Economics Please note: $20001 - $100000 Added 05/31/2019 by Anupam Jena, source=Web Response, value=Consulting fee No relevant relationships Added 05/28/2019 by Richard Murphy, source=Web Response, value=Consulting fee Removed 05/28/2019 by Richard Murphy, source=Web Response No relevant relationships by Jesse Sussell, source=Web Response Employee relationship with Precision Health Economics Please note: $20001 - $100000 Added 06/12/2019 by Emma van Eijndhoven, source=Web Response, value=Salary