JMIR Publications

ABSTRACT

The management of chronic obstructive pulmonary disease (COPD) presents a significant burden to healthcare systems across the world. Home noninvasive positive pressure ventilation (NPPV) is an established treatment option associated with significant benefits for COPD patients with hypercapnic chronic respiratory failure. However, challenges remain in ensuring treatment effectiveness. This study aimed to assess the cost-effectiveness of Internet of Things (IoT)-based management versus standard management of home NPPV in COPD patients with hypercapnic chronic respiratory failure. A Markov decision analytic model was developed to simulate real-world COPD progression and predict health outcomes and costs associated with IoT-based and standard management of home NPPV. Efficacy and cost inputs were primarily sourced from a published multicenter, prospective, randomized controlled trial and supplemented by official Chinese databases where necessary. The discounted lifetime cost per quality-adjusted life-year (QALY) gained was calculated from Chinese healthcare payer perspective, and sensitivity analyses were conducted to test the robustness of model results across different assumptions. Compared to standard NPPV, IoT-based NPPV increased costs by ¥3,607.26 and improved QALYs by 0.24 per person across the lifetime horizon, resulting in an incremental cost-effectiveness ratio of ¥15,030.25 per QALY with a 93.6% probability of being cost-effective at the given willingness-to-pay threshold. Base case results were also robust to multiple one-way sensitivity analyses, with the main drivers being hospitalization costs of standard and IoT-based NPPV groups during the period of serious exacerbation. IoT-based NPPV was cost-effective compared to standard NPPV for COPD patients with hypercapnic chronic respiratory failure.