Chronic Obstructive Pulmonary Disease (COPD) research at ResMed
ResMed supports multiple global trials that are investigating morbidity and mortality benefits, as well as biomarkers, quality of life and other outcomes in COPD patients treated with non-invasive ventilation (NIV).
The study population included severe hypoxic and hypercapnic COPD patients who had been hospitalised for acute decompensated hypercapnic exacerbation of COPD requiring NIV.
Patients receiving both HOT (home oxygen therapy) and HMV (home mechanical ventilation) had a median admission-free survival of 4.3 months versus 1.4 months for those receiving HOT alone. This translates to an increase of over 90 days in the median time to first event for the HOT-HMV arm.
Key findings of HOT-HMV
A 51% reduction in the risk of hospital readmission or death in the HOT-HMV arm compared to the HOT arm.
The absolute risk reduction at 12 months was 17%, translating to a need to treat 6 patients to avoid one hospital readmission or death in 12 months.
74% of reduction in the risk of hospital readmission in the first 28 days after randomisation with two-thirds fewer events observed in this period.
In addition to the positive effect on time to first readmission or death*, further analysis showed that the exacerbation rate was reduced by 34% in the HOT-HMV arm.
*Median time to first event.
High pressure ventilation effectively reduced CO2 levels and therapy was well tolerated, as shown by results on quality of life and compliance.
Cost effectiveness of HOT-HMV therapy
Following the outcome of the HOT-HMV study1, a health economics analysis was performed to assess the cost effectiveness of HOT-HMV when compared to HOT alone among COPD patients in the UK with persistent hypercapnia after a life-threatening exacerbation.2
The Incremental Cost-Effectiveness Ratio (ICER) was calculated based on the total cost of each intervention relative to the respective quality adjusted life year (QALY). QALY is a year of life adjusted for its quality or its value. The base-case incremental cost/QALY gained was £10,360. The analysis indicates that the probability of HOT-HMV being cost-effective is 62%, based on willingness to pay.
The combined outcomes of the HOT-HMV trial and the health economic analysis show that, in the UK, home oxygen therapy plus home mechanical ventilation is both clinically efficacious and cost-effective.
The HOT-HMV study was sponsored by ResMed.
The HOmeVent registry is an observational, non-interventional medical device registry which aims to determine the prevalence of chronic hypercapnic COPD patients in an outpatient setting during routine visits for COPD.
231 COPD patients had been registered by the end of June 2018. 28.1% showed signs of hypercapnia (PaCO2 ≥45 mmHg) with 10% scoring PaCO2 ≥50 mmHg. This shows that a significant proportion of COPD patients in GOLD stage 3 and 4 exhibit chronic hypercapnia and might therefore be candidates for NIV treatment.
References
- Murphy P et al. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation. A Randomized Clinical Trial, JAMA. Published online May 21,2017. doi:10.1001/jama.2017.4451.
- Murphy PB et al. Cost-Effectiveness of Home Oxygen Therapy-Home Mechanical Ventilation (HOT-HMV) for the Treatment of Chronic Obstructive Pulmonary Disease (COPD) with Chronic Hypercapnic Respiratory Failure Following an Acute Exacerbation of COPD in the United Kingdom (UK). American Journal of Respiratory and Critical Care Medicine 2018;197:A2517
- Dreher M et al. Registry of Stable Hypercapnic Chronic Obstructive Pulmonary Disease Treated With Non-Invasive Ventilation -HOmeVent Registry. ATS, San Diego, 2018. ClinicalTrials.gov Identifier:NCT02811588
