At Home Noninvasive Ventilation for COPD Saves Time & Money

By Teofilo Lee-Chiong, MD | Published 2/28/2018 0

Compressor nebulizer with mask on color background 1999 x 1333

Chronic respiratory diseases are among some of the most common and costly health problems, affecting millions of people all over the world. One respiratory condition in particular that remains a growing concern for the healthcare industry is chronic obstructive pulmonary disease (COPD).

COPD is one of the leading causes of death, third in the U.S. and estimated third worldwide by 2030. In addition to the millions of patients already diagnosed, COPD is commonly misdiagnosed and underdiagnosed, with a predicted 12 million Americans to have the disease without even knowing it. Not only is COPD among the most common and most debilitating to patients, but it also places an economic burden on the healthcare industry. The disease is a reason for substantial increases in costs, due to the result of inpatient readmission rates, with associated costs estimated to be $50 billion by 2020.

Despite the number of affected people and costs associated with COPD, the conversations continue to be limited around awareness, diagnosis, and treatment options. While there is no cure for the disease, there are a range of treatment options that physicians can provide their patients, whether they are newly diagnosed or late-stage that can help to improve their quality of life.


It all starts with a proper diagnosis

COPD can be easily misdiagnosed as it has similar symptoms to many other lung conditions. Early COPD symptoms can include shortness of breath, a chronic cough, and body fatigue that might be misinterpreted by patients, as signs of the normal aging process. Patients should be encouraged to come forward with these symptoms, especially if they are a current or past smoker. Doing so allows physicians to provide reliable lung assessments such as spirometry, which can help detect COPD earlier before major lung damage develops. Physicians can then assist patients with a personalized treatment plan that will enable them to live a better, fulfilled life.


Coming to terms with your diagnosis

Receiving a COPD diagnosis is life changing for a patient and frequently is followed by the question “now what?” A diagnosis requires patients to change their current lifestyle and regular routine. Education is key, as many COPD patients don’t know what it means to have COPD, how it will impact their current lifestyle, habits, and relationships, and the available treatment options that can help manage their condition.

While COPD is a chronic condition, it doesn’t need to be a debilitating disease. There are steps patients can take such as creating an action plan for future exacerbations, exercise to strengthen lung function, attend pulmonary rehabilitation, and, of course, quit smoking. The most critical component to understanding COPD is making patients aware of available treatment options that can drastically change their lives for the better. Patients must have a more educated conversation with their physician about care management programs and the available care therapies.


Leveraging existing treatment options for improved care

An ongoing challenge for the healthcare industry is finding the right therapy for COPD patients. Each patient is at a different stage of the disease with different symptoms, and there is no “one size fits all” approach for COPD.

Advances in scientific knowledge have led to better therapies for COPD. Positive airway pressure (PAP) therapy, specifically noninvasive ventilation (NIV) therapy, is a treatment used to reduce blood CO2 levels in COPD patients. NIV therapy tailors ventilation pressure to match the patient’s breathing patterns in order to maximize oxygen and has shown to alleviate symptoms of respiratory discomfort. It has also been shown to reduce readmissions and save money.

In addition to PAP therapy, other novel treatment options are nebulizers, designed to provide fast and efficient aerosol drug delivery with shorter treatment times and portable oxygen concentrators that help to provide patients’ with the freedom to live a full life.


Study: Advanced NIV saves reduces hospitalizations and saves money

A Philips-funded study demonstrated that both hospitals and payers can benefit from significant reductions in hospitalizations, readmissions, and healthcare costs by providing patients with NIV therapy at home in the context of a multifaceted program that includes oxygen therapy, respiratory therapist-led care, patients education, and medication reconciliation.

The study, titled, “Cost Savings from Reduced Hospitalizations with Use of Home Noninvasive Ventilation for COPD,” compared savings associated with the use of advanced NIV, less advanced NIV (a respiratory assist device with bilevel pressure capacity), or no NIV. Savings were calculated at 30 and 90 days for 250 patients with severe COPD in a single hospital study and 3 years cumulative for 100,000 patients in a payer database.

The advanced NIV used in the study was the Philips Trilogy 100 with AVAPS-AE mode. The Trilogy is a portable ventilator designed for use outside of the hospital. AVAPS-AE is an auto-titration mode of NIV with multiple algorithms that work simultaneously to meet the changing needs of individual patients. It’s three main components are:

  • AVAPS – automatically adjusts to a patients breathing
  • Auto-EPAP – proactively adjusts peak air pressure to the lowest effective level for patient comfort
  • Auto-backup – reduces air trapping by delaying a machine breath until the patient has exhaled

Key findings of the study were the following:

  • A reduction in hospitalizations led to cumulative savings of $402,981 over 30 days and $449,101 over 90 days with a multifaceted therapy approach using Philips Trilogy in-home advanced NIV therapy versus no NIV treatment or less advanced NIV therapy devices.
  • Payers studying admissions of 100,000 severe COPD patients had cumulative 3-year savings of $326 million when using home NIV in comparison to no NIV treatment.


Providing improved COPD care through

With the industry shifting toward a value-based care model, physicians are looking for innovative, patient-centered care through proven, multifaceted treatment options that provide both better patient care and lower healthcare costs associated with that care. As the number of COPD patients continue to rise and technology continues to improve delivery of effective therapy, we have a vast opportunity to achieve both goals.

Teofilo Lee-Chiong, MD

Teofilo L. Lee-Chiong Jr., MD is a Professor of Medicine at National Jewish Health in Denver and at the University of Colorado Denver School of Medicine. He has authored or edited 16 textbooks in Sleep Medicine and Pulmonary Medicine, has more than 150 publications, has given more than 300 presentations in the United States and internationally, and has participated in more than 30 research projects. In addition, he developed and serves as the consulting editor of Sleep Medicine Clinics, and is a member of the editorial board and reviewer of several medical journals and publications. Dr. Lee-Chiong completed his internship and residency in internal medicine and his pulmonary and critical care medicine fellowship at Yale, and his post-fellowship training in Sleep Medicine at Dartmouth. He joined Philips Respironics as its Chief Medical Liaison in 2011.

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