Impact of High-Frequency Chest Wall Oscillation on Health Care Resource Use and Economic Outcomes in Adult Patients With Non-Cystic Fibrosis Bronchiectasis in the United States

Background

Airway clearance therapy is prescribed to patients with bronchiectasis, but limited evidence exists demonstrating the effectiveness of medical device treatment options.

Research Question

What is the impact of high-frequency chest wall oscillation therapy (HFCWO) on health care resource use (HCRU) and economic outcomes in patients with bronchiectasis in the United States?

Study Design and Methods

A retrospective pre-post cohort study was conducted using the PharMetrics Health Plan Claims Database. The study included commercially insured adult patients with bronchiectasis receiving HFCWO between January 2009 and February 2018. Health care claims were compared 12 months before and after initiation of HFCWO. End points included all-cause and disease-specific HCRU and costs. Comparisons were conducted using McNemar’s test for categorical variables and the Wilcoxon signed-rank test for continuous variables.

Results

A total of 255 patients were included. Mean age was 55.6 years, and 58% were high risk. Compared with baseline, significant reductions in all-cause hospital length of stay (9 vs 6 days; P = .05), oral antibiotics (89% vs 80%; P = .002), IV antibiotics (12% vs 6%; P = .01), and radiology examinations (96% vs 92%; P = .03) were observed. For disease-specific outcomes, significant reductions in hospitalizations (8% vs 3%; P = .004), acute exacerbations (7% vs 2%; P = .007), outpatient physician office visits (87% vs 78%; P < .001), radiology examinations (58% vs 34%; P < .0001), and laboratory services (51% vs 38%; P = .001) were found. Significant reductions in disease-specific costs were identified, including inpatient hospitalizations, pulmonologist visits, and radiology examinations; however, despite these reductions, all-cause total cost data were similar for both periods because of the cost of the device.

Interpretation

HFCWO therapy is associated with lower HCRU 12 months after initiation of therapy. Further health economic studies are required to determine if cost savings offset cost of the device after 1 year.