Résumé
RATIONALE: Long-term oxygen therapy (LTOT) is the recommended for patients with severe Chronic Obstructive Pulmonary Disease (COPD) and other forms of chronic respiratory failure (CRF). We aimed to describe and compare the efficacy, burden, and cost of illness of patients treated with portable oxygen concentrator (POCs) therapies based on baseline mobility level.METHODS: A nationwide retrospective analysis of POC treated COPD- and CRF-adult patients based on the French health administrative database SNDS. Patients were included at the first delivery of LTOT device, between 2014 to 2019, and followed up to December 2020. Two sub- populations of POC users were distinguished by higher mobility (POCs autonomy higher than 5 hours, Inogen only devices, HM) and lower mobility (POCs autonomy lower than 5 hours, all non- Inogen devices, LM). Patient baseline characteristics and LTOT treatment patterns were described. Overall survival (OS) comparison was estimated by the Kaplan Meier method, log-rank test, and Cox model. Propensity score matching (1:1) allowed to control for age, gender, comorbidities, and stationary concentrator (SC) equipment. All-cause inpatient hospitalizations, emergency visits, physician visits, and all-cause death were evaluated. Costs were evaluated from the healthcare payer perspective. RESULTS: Among the 40,617 COPD and CRF patients equipped with POCs, 21,987 and 18,630 were identified in the LM and HM groups, respectively. Before matching, the HM group had higher proportion of men compared to the LM group (57% versus 52%), and an average age of 72 (SD 11) years for HM and 75 (SD 12) for LM. In addition to POCs, some patients used SC (45% LM versus 40% HM). The median overall survival (mOS) was 37 and 53 months in LM and HM. After matching, 17,099 were included in each group. The mOS of LM remained lower compared to the HM group (43 months versus 53 in HM). The relative risk of death was 19% lower (HR 0.81 [95% CI 0.78 - 0.83]) in the HM group. Both groups had similar risk of all-causes and respiratory hospitalizations, and ER visits. Total healthcare costs per patient per year were 14% higher in the LM group, 13,503€ versus 11,863€ HM. The calculation of the incremental cost-effectiveness ratio (ICER) showed that POCs with HM are cost-saving (-168€ per year of life gain) compared to LM. CONCLUSIONS: LTOT patients with higher mobility have higher life expectancy and should continue to receive POCs with higher duration of autonomy based on clinical and cost effectiveness benefits.