Home non-invasive mechanical ventilation and long-term oxygen therapy in stable hypercapnic chronic obstructive pulmonary disease patients: comparison of costs.

BACKGROUND: A cost analysis of nocturnal non-invasive ventilation (NNV) in stable chronic obstructive pulmonary disease (COPD) patients would be helpful in decision making, when the balance between the increased demand and the availability of resources should be checked. OBJECTIVES: Based on data from the Italian trial in stable hypercapnic COPD patients, this study compares the cost of care associated with the use of NNV when added to the usual long-term oxygen therapy (LTOT) with the cost of care of LTOT regimen alone. METHODS: Cost was calculated in 77 of 90 patients included into that trial. Analysis included drug therapy, hospitalisations due to acute exacerbation, oxygen and ventilator equipment. An estimation of charges was made according to the national sources of cost for drugs and hospital admissions and the actualised reimbursement for the home care provided to both oxygen and ventilator users. The cost/day comparison was made between the individual patients in the 2 groups (NNV + LTOT, n = 35; LTOT, n = 42). RESULTS: The mean cost of drugs and oxygen was similar in both groups, whereas the cost of hospitalisation tended to be lower in NNV + LTOT compared to LTOT alone (8.25 +/-10.29 vs. 12.50 +/- 20.28 EUR/patient/day, p < 0.05). Inclusion of the ventilator equipment increased the total cost to 23.73 EUR/day in the NNV + LTOT compared to 21.42 EUR/day in the LTOT group (not significant). CONCLUSIONS: The present report suggests that long-term management with addition of non-invasive ventilation does not increase costs compared with the usual LTOT regimen: the hospital-related costs were reduced when using the ventilator in these hypercapnic COPD patients.

Uro-gramma: the importance of updating the predictive model.

OBJECTIVES: Uro-gramma is a probabilistic predictive model of pathological staging of prostate cancer (Pca) from preoperative parameters (PSA, clinical Gs, clinical stage) published in 2000. Aim of this study is to improve Uro-gramma, updating it, to take into account the continuous evolution of the population. MATERIALS AND METHODS: From 1998 to 2000, 991 Pca patients have undergone radical prostatectomy in several Italian urological centers. Inclusion criteria were: preoperative PSA < 50 ng/ml, clinical stage < or = T3c, availability of a bioptic Gs and pathological staging. A predictive model has been estimated for each year and its behaviour on the following years tested, using Hosmer and Lemeshow tests, which compare the expected rate with the observed one. RESULTS: The mean age was 66.3 years. Pca familiarity was present in 3.2% of the patients in 1998, 2.6% in 1999 and 7.4% in 2000. PSA values < 10 have increased (from 41% to 47%) and those > 10 decreased (from 59% to 53%). The mean number of bioptic samples per patient has increased from 4.9 to 6, while clinical and pathologic Gs have remained stable. An increase in the rate of organ confined Pca has been noticed, either clinically (87.4% in 1998, 92% in 2000) or pathologically (55.2% in '98, 57% in 2000). Staging lymphadenectomy has been performed in 88% of the pts in 1998, 94.2% in 1999 and 94.5% in 2000, whereas the % of N+ patients has moved from 11.3% in 1998 to 9.8% in 2000. CONCLUSIONS: Uro-gramma update results show that the mean estimate error has fallen from 6.4% to 1.2%. The new model strengthens the previous one and confirms its validity, but it also underlines the need of a constant update to take into account the continuous evolution of the population and of the methods of diagnosis and staging.