Assessment of health-related quality of life and hospital admission costs of domiciliary High-Flow nasal cannula treatment for severe COPD with chronic hypoxic failure

Introduction: Domiciliary High Flow Nasal Cannula (HFNC) has been shown to reduce days of hospitalization in COPD-patients with chronic hypoxic failure (CHF).

Aim: To evaluate development in health-related quality of life (HRQoL) and costs related to hospital admissions in HNFC treated COPD patients with CHF compared to controls.

Method: In a cohort of 200 COPD patients randomized equally into usual care ± HFNC, complete HRQoL data, judged by St. Georg Respiratory Questionnaire (SGRQ), were available in 140 patients (66 HFNC and 74 controls). The SGRQ data were used to predict EQ-5D utility values using a validated algorithm developed by Starkie et al. Based on this, Quality-Adjusted Life-Years (QALYs) were calculated, and QALYs were corrected for baseline HRQoL and days of treatment.The cost of hospital admission due to COPD exacerbation (AECOPD) was calculated for the same 140 patients during the study period using mean daily admission costs. The cost was corrected for cost of AECOPD admissions in the year prior to inclusion and days of treatment. Costs were valued in British Pounds (£) at price level 2019.

Results: HNFC treatment resulted in a QALY improvement of 0.045 (95% CI -0.017; 0.107) and a mean decrease in cost of £ -1290 (95% CI -2710; 131) per patient. No statistically significant differences were observed.

Conclusion: HNFC treatment led to a gain in QALYs and resulted in savings in hospital admission costs when compared to usual care. Further analysis will reveal whether HNFC for COPD patients with CHR is a cost-effective treatment when considering all relevant cost categories.