Abstract
Introduction: Guidelines recommend that OHS patients are electively admitted to hospital for initiation of home NIV, but it is unknown whether OP setup is safe and as effective as IP setup. We hypothesised that OP NIV setup would be more cost-effective than IP NIV setup.
Method: OHS patients were recruited to a multicentre international clinical trial. Patients were randomised to IP setup, using nurse-led overnight titration with standard fixed level NIV, or OP setup using an auto-titrating NIV device (AVAPS-AE, Philips, US). Primary outcome was cost-effectiveness difference at 3 months with carbon dioxide (PaCO2) embedded as an a priori non-inferiority clinical effectiveness safety outcome. Costs were converted to UK £ sterling 2017.
Results: 82 patients were randomised (41 IP vs. 41 OP; 53 UK, 29 France). Baseline data were matched with age 59±14yrs, body mass index (BMI) 47±10kg/m2, PaCO2 6.8±0.6kPa and severe respiratory insufficiency questionnaire (SRI) 52±19. There was no difference at 3 months between OP vs. IP setup in additional quality adjusted life months (QALM), total cost, SRI or PaCO2 (non-inferior).[Table 1]
Conclusion: OP NIV setup in OHS, using an auto-titrating device, has similar cost as IP setup using nurse-led overnight titration NIV. There was no difference in clinical effectiveness or safety between IP and OP setup.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, RCT5099.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019