NONINVASIVE VENTILATION AT HOME REDUCES MORTALITY AND HEALTHCARE UTILIZATION IN COPD WITH CHRONIC RESPIRATORY FAILURE IN MEDICARE BENEFICIARIES

Abstract

SESSION TITLE: New Insights into COPD and Its Complications SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Chronic respiratory failure due to Chronic Obstructive Pulmonary Disease (COPD-CRF) is associated with higher mortality risk and increased healthcare utilization. In recent years, non-invasive home ventilation (NIVH) has become increasingly used in patients with COPD-CRF. This study aims to investigate the association of NIVH with risk of death, hospitalizations, and emergency room (ER) visits in COPD-CRF Medicare beneficiaries in the US. METHODS: A time-to-event analysis was conducted using claims data from the Medicare Limited Data Set between 2012 and 2018. The study sample included COPD-CRF Medicare beneficiaries who received NIVH within two months post CRF diagnosis (treatment group), and patients with COPD-CRF not receiving NIVH during the study period (control group). The study outcomes of interest were overall survival, time to first hospitalization, and time to first ER visit post CRF diagnosis. To minimize confounding, propensity score methods with 1:1 nearest neighbor matching were used to match the treatment and control group. Cox proportional hazards regression models with bootstrapped standard errors were used to estimate the treatment on the treated effect of NIVH on risk of mortality, hospitalization and ER visits. Adjusted Hazards Ratio (aHR) and corresponding 95% Confidence Intervals (CIs) were reported. The risk difference (RD), relative risk reduction (RRR), and number needed to treat (NNT) at one-year post CRF diagnosis were also estimated. RESULTS: After matching, 517 patients with COPD-CRF receiving NIVH (treatment group; mean age 70.6, 44% male, and 86% white) and 511 patients with COPD-CRF who did not receive NIVH (control group) were included. NIVH significantly reduced the risk of death by 50% (aHR: 0.50; 95%CI: 0.36-0.65), the risk of hospitalization by 28% (aHR: 0.72; 95%CI: 0.52-0.93), and the risk of ER visit by 52% (aHR: 0.48; 95% CI: 0.38-0.58) (p<0.01). The treatment benefit remained constant for hospitalizations over the entire study period, but decreased for both death and ER visits. One-year post CRF diagnosis, a RD of 18.0%, with a RRR of 39.3% was observed for survival, a RD of 11.3%, with a RRR of 17.0% for hospitalizations, and a RD of 20.2%, with a RRR of 22.0% for ER visits. The NNT were 5.5, 8.8, 4.9 to prevent a death, hospitalization, and ER visit within the first year post CRF diagnosis, respectively. CONCLUSIONS: NIVH treatment was found to reduce the risk of death, hospitalizations, and ER visits significantly among Medicare beneficiaries with COPD-CRF. The study findings highlight the potential incremental value of NIVH over current medical treatment in reducing the healthcare burden among patients with CRF due to COPD. CLINICAL IMPLICATIONS: NIVH may currently be underutilized and should be considered in all patients with COPD-CRF. DISCLOSURES: Board Member relationship with Viemed Please note: $20001 - $100000 Added 06/01/2020 by William Frazier, source=Web Response, value=Restriced Stock Units Employee relationship with Viemed Please note: >$100000 Added 06/01/2020 by William Frazier, source=Web Response, value=Salary no disclosure on file for Richard Murphy; Employee relationship with PRECISIONheor Please note: $20001 - $100000 Added 05/31/2020 by Emma van Eijndhoven, source=Web Response, value=Salary