Abstract
Background: Weakness in the muscles used to breathe and swallow can lead to difficulties with airway clearance for people with neurological disorders including neuromuscular disease and cerebral palsy. This can lead to aspiration and other respiratory problems which are the leading causes of death in patients with complex neurological disorders. The Vest™ system supports airway clearance through the use of High-Frequency Chest Wall Oscillation (HFCWO) to loosen secretions in the chest by reducing their viscosity. Objective: To assess the cost-effectiveness of the Vest™ system versus Manual Chest Wall Physiotherapy (MCWP) for airway clearance in patients with neurological disorders including neuromuscular disease and cerebral palsy. Methods: A decision-analytic Markov model was developed to estimate the cost-effectiveness of HFCWO and MCWP over 5- and 10-year time horizons. Costs were estimated from the perspective of the UK National Health Service and personal social services. The main input parameters in the model were: rates of respiratory infection, respiratory-related hospitalisation, antibiotic use for respiratory infection and cost of the Vest™ system. The input parameters were informed by existing clinical guidelines and literature. Sensitivity analyses were conducted to explore uncertainties around the input parameters. Results: Over 5- and 10-year time horizons, the Vest™ system results in more quality-adjusted life-years and lower costs per patient. The Vest™ system has a high probability of being cost-effective (>98%) at willingness-to-pay thresholds of £20,000 and £30,000. The estimated average cost saving per patient over a 5-year time horizon is £5,660 (SD = £2362). Our results show that the Vest™ system may result in approximately £6 million cost savings per 1,000 patients with complex neurological disorders in 5 years. Per 1,000 patients, 2,442 hospital admissions and 49,868 bed days could be averted with the use of the Vest™ system. Our results were generally robust to the sensitivity analyses performed. Conclusion: The Vest™ system results in fewer respiratory infection episodes and hospitalisations, and thus less National Health Service (NHS) resource use, than current practice. Therefore, it is highly likely to be a cost-saving strategy.
Highlights
Weaknesses in the muscles used to breathe and swallow can contribute to respiratory problems in patients with complex neurological disorders including neuromuscular disease and cerebral palsy [1]
Our results show that the VestTM system may result in approximately £6 million cost savings per 1,000 patients with complex neurological disorders in 5 years
The VestTM system results in fewer respiratory infection episodes and hospitalisations, and less National Health Service (NHS) resource use, than current practice
Summary
Weaknesses in the muscles used to breathe and swallow can contribute to respiratory problems in patients with complex neurological disorders including neuromuscular disease and cerebral palsy [1]. Ineffective airway clearance can lead to aspiration of saliva, liquids, or food These patients often present with conditions such as pneumonia or other lower respiratory tract infections, pleural effusion, or respiratory failure resulting from ineffective airway clearance. These conditions often require lengthy hospital admissions and significant resource use [2]. Weakness in the muscles used to breathe and swallow can lead to difficulties with airway clearance for people with neurological disorders including neuromuscular disease and cerebral palsy This can lead to aspiration and other respiratory problems which are the leading causes of death in patients with complex neurological disorders. The VestTM system supports airway clearance through the use of High-Frequency Chest Wall Oscillation (HFCWO) to loosen secretions in the chest by reducing their viscosity
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