Cost-effectiveness of home mechanical ventilation in children living in a developing country

Background
Home mechanical ventilation is a promising option for children requiring long-term mechanically assisted ventilation, despite data on the cost-effectiveness of this approach being limited. The aim of the study was to investigate the cost-effectiveness of home mechanical ventilation in children requiring long-term mechanically assisted ventilation

Methods
A retrospective cohort study was conducted on 67 children (32 girls, 47.7%) requiring mechanically assisted ventilation. The underlying diseases of the children concerned were as follows: congenital airway malformations in 24; cystic fibrosis in 4; severe laryngomalacia in 16; polyneuropathy syndrome in 6; mitochondrial myopathy in 5; hypoxic ischaemic encephalopathy in 6; and cerebral palsy in 2. The children were admitted to paediatric intensive care units (ICU) for 2 weeks. After discharge, they were placed on home mechanical ventilation and were followed-up for 1 year. Data on the daily costs of hospital stay at the ICU, re-hospitalisations, weaning, educational performance and muscle strength were gathered.

Results
The mean age of children at time of initiation of mechanically assisted ventilation was 5.2 ± 4.9 years (ranging from 2 months to 15 years). The mean number of re-hospitalisations was 3.6 ± 4.9 times with a mean duration of 53.2 ± 44.9 days. Of the children on mechanical ventilation, 1 was attending school, 2 had been weaned, and 21 had experienced improvement in muscle strength. No fatal or serious complications were observed while the children were on home mechanical ventilation. The median (IQR) cost of daily ICU stay admission was USD 3,625.0 (USD 7,075.0), while the median daily cost of home mechanical ventilation was USD 1,402.0 (USD 1,044.2) (P < 0.001).

Conclusions
Home mechanical ventilation is more cost-effective compared with ICU stay for only mechanically assisted ventilation.