HEALTHCARE UTILIZATION AND COSTS OF HOME MECHANICAL VENTILATION.

INTRODUCTION/OBJECTIVE: Individuals using home mechanical ventilation (HMV) frequently choose to live at home for quality of life, despite financial burden. Previous studies of healthcare utilization and costs do not consider public and private expenditures, including care-giver time. This study determined public and private healthcare utilization and costs for HMV users living at home in two Canadian provinces, and examined factors associated with higher costs. METHODOLOGY: Longitudinal, prospective observational study (April 2012 to August 2015) collecting data on public and private (out-of-pocket, third party insurance, caregiving) costs every 2 weeks for 6 months using the Ambulatory Home Care Record. Functional Independence Measure (FIM) was used at baseline and study completion. Regression models examined variables associated with total monthly costs. A priori variables selected using Andersen and Newman's framework for healthcare utilization, relevant literature, and clinical expertise. Data in 2015 Canadian dollars. RESULTS: We enrolled 134 HMV users; 95 with family caregivers. Overall median (interquartile range) monthly healthcare cost was $5275 ($2291-$10,181) with $2410 (58%) publicly funded; $1609 (39%) family caregiving; and $141 (3%) out-of-pocket (<1% third party insurance). Median healthcare costs were $8733 ($5868-$ 15,274) for those inva-sively ventilated and $3925 ($1212-$7390) for non-invasive ventilation. Variables associated with highest monthly costs were Amyotrophic Lateral Sclerosis (1.88, 95% CI 1.09-3.26, p < 0.03) and lower FIM quintiles (higher dependency) (up to 6.98, 95% CI 3.88-12.55, p < 0.0001) adjusting for age, sex, tracheostomy, and ventilation duration. CONCLUSIONS: For individuals using HMV and living at home, most healthcare costs were publicly supported or associated with family care-giving. Highest costs were incurred by the most dependent users. Understanding healthcare costs for community-residing HMV users will inform policy decisions to optimize resource allocation, helping these individuals live at home while minimizing caregiver burden. [ABSTRACT FROM AUTHOR]