Health Care Utilization and Costs in Ventilator-Dependent Children and Adults Receiving an eHealth Intervention During the COVID-19 Pandemic

Abstract

Background:

During the COVID-19 pandemic, we implemented the Long-term In-Home Ventilator Engagement (LIVE) intervention to provide virtual specialist care. Using a matched home mechanical ventilation control group, we compared publicly funded health-service utilization and costs for ventilator-dependent children and adults receiving the LIVE eHealth intervention.

Methods:

LIVE users were matched to controls on age, sex, ventilation type, years on ventilation, and reason for ventilation. The Ventilator Equipment Pool database was linked to health administrative data, which contains medically necessary health care service information on the entire population. We used analysis of covariance and generalized estimating equations to estimate the effect of the LIVE program on health care utilization and costs, controlling for 12-month prior health care utilization. We used Kaplan–Meier curves to compare survival rates.

Results:

Of the 250 LIVE users, we were able to 1:1 match 178 with home mechanical ventilation controls. Adjusted rate ratios for most outcomes resulted in elevated costs and utilization in the post period attributable to LIVE; however, most did not reach statistical significance. All-cause in-patient admissions (16%), out-patient pulmonology visits (41%), and general practitioner costs (77%) were significantly elevated in LIVE participants in the post period. There was no statistically significant difference in survival between the groups.

Conclusions:

LIVE users had higher rates of out-patient pulmonology visits, in-patient admissions, and general practitioner visit costs, but no difference in overall costs or mortality. This study highlights the limitations of evaluating eHealth interventions through observational research and the need for a randomized controlled trial.