Advanced COPD patients under home mechanical ventilation and/or long term oxygen therapy: Italian healthcare costs.

BACKGROUND AND AIM: Little information is available on healthcare costs for patients with very severe chronic obstructive pulmonary disease. The aim of the current work was to evaluate Italian healthcare costs in these patients.

METHODS: Prospective 1-year analysis was assessed in three subgroups of patients; non-invasively ventilated (n=30); invasively-ventilated (n=12) and on long-term oxygen therapy (n=41). Acute costs for care were a sum of fees for doctor's consultations, admissions to hospital (ward and intensive care units) and emergency drugs. Chronic costs were the sum of costs for pharmacotherapy and home ventilation and/or oxygen care.

RESULTS: Mean cost/day/patient was 96 +/- 112 Euro (range 9-526 Euro), with acute costs accounting for 72% and chronic costs for 28% of the total cost burden, with no significant differences in costs associated with the three subgroups. Acute costs had a non-normal distribution (range 0 to 510 Euro) being cost for hospitalisation the highest cost burden with more than 30% of acute care costs attributed to only a small segment of patients. Chronic care costs were also unevenly distributed among the various groups (ANOVA p = 0.006), being home oxygen supply the highest cost burden.

CONCLUSIONS: The current Health Care System is in urgent need for a reassessment of the high cost burden associated with hospitalisations and home oxygen supply.