Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jan 15, 2025
Date Accepted: Apr 20, 2026
Cost-effectiveness of Internet of Things-based management of home noninvasive positive pressure ventilation in COPD patients with hypercapnic chronic respiratory failure: a trial based economic evaluation
ABSTRACT
Background:
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. Internet of Things (IoT) -based management will improve communication between patients and doctors, and strengthen the integration and comprehensiveness of home NPPV telemonitoring. However, the economic value of such systems remains insufficiently understood.
Objective:
This study aimed to assess the cost-effectiveness of IoT-based management versus standard management of home NPPV in COPD patients with hypercapnic chronic respiratory failure.
Methods:
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. COPD progression consisted four health states: Stable period, Non-serious exacerbation period, Serious exacerbation period, and Death. Efficacy and cost inputs were primarily sourced from a published multicenter, prospective, randomized controlled trial and supplemented by official Chinese databases where necessary. Quality-adjusted life years (QALYs) were used as effect indicators of this model, which were derived from COPD Assessment Test (CAT) scores. The discounted lifetime cost per QALY gained was calculated from Chinese healthcare payer perspective, and sensitivity analyses were conducted to test the robustness of model results across different assumptions.
Results:
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.
Conclusions:
IoT-based NPPV was cost-effective compared to standard NPPV for COPD patients with hypercapnic chronic respiratory failure.
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