OBJECTIVES

Evaluate the available evidence for Invasive Home Mechanical Ventilation (IHMV) and develop Budget Impact and Cost-Effectiveness analyses to estimate the impact of a potential inclusion and reimbursement of the technology in the Brazilian Public Healthcare System (SUS), and the associated patient hospital discharge for home treatment.

METHODS

A retrospective analysis of the electronic database from the Brazilian Ministry of Health identified the four most common pathologies for Invasive Hospital Mechanical ventilation. A cost-effectiveness study was performed to calculate whether IHMV could be cost-effective when compared to the hospital treatment. A Markov model included cycles of one year to simulate the life of patients. Budget Impact analysis estimated the potential impact of such technology incorporation and reimbursement on the budget of SUS over a period of five years.

RESULTS

The available IHMV outcomes indicate that mortality tends to be not significantly different between hospital and home Invasive Mechanical Ventilation (IMV) groups, with a low re-hospitalization rate in IHMV group. The incorporation of IHMV can result in a cost reduction of R$ 9.31 billion in 5 years for SUS. In all scenarios, IHMV generates QALYs and unoccupied day beds. Hospital IMV total treatment costs 11.5 times higher than IHMV. The use of IHMV can also release 1.618 hospital beds per year for SUS.

CONCLUSIONS

Despite the limited clinical evidence around IHMV and significant costs related to the transfer of hospital-based patients to their homes, the incorporation of IHMV in the Public Health System of Brazil is recommended considering the release of hospital and its clinical, economic and societal benefits.