Prevalence and variability of use of home mechanical ventilators, positive airway pressure and oxygen devices in the Lombardy region, Italy

Submitted: August 16, 2017
Accepted: December 17, 2017
Published: January 29, 2018
Abstract Views: 1263
PDF: 685
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Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV) in Italy. We aimed to investigate the prevalence and prescription variability of HMV as well as of long-term oxygen therapy (LTOT) and continuous positive airway pressure (CPAP), in the Lombardy Region. Prescribing rates of HMV (both noninvasive and tracheostomies), CPAP (auto-CPAP, CPAP/other sleep machines) and LTOT (liquid-O2, O2-gas, concentrators) in the 15 Local Healthcare districts of Lombardy were gathered from billing data for 2012 and compared. Crude rates (per 100,000 population) and rates for the different healthcare districts were calculated. In 2012, 6325 patients were on HMV (crude prescription rate: 63/100,000) with a high variation across districts (8/100,000 in Milano 1 vs 150/100,000 in Pavia). There were 14,237 patients on CPAP (crude prescription rate: 142/100,000; CPAP/other sleep machines 95.3% vs auto-CPAP 4.7%) with also high intra-regional variation (56/100,000 in Mantova vs. 260/100,000 in Pavia). There were 21,826 patients on LTOT (prescription rate: 217/100,000 rate; liquid-O2 94%, O2-gas 2.08%, O2-concentrators 3.8%), with again high intra-regional variation (100/100,000 in Bergamo vs 410/100,000 in Valle Camonica). The crude rate of HMV prescriptions in Lombardy is very high, with a high intra-regional variability in prescribing HMV, LTOT and CPAP which is partly explainable by the accessibility to specialist centers with HMV/sleep-study facilities. Analysis of administrative data and variability mapping can help identify areas of reduced access for an improved standardization of services. An audit among Health Payer and prescribers to interpret the described huge variability could be welcomed.



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Supporting Agencies

Michele Vitacca, Istituti Clinici Scientifici Maugeri
Respiratory Rehabilitation Division
Luca Barbano, Istituti Clinici Scientifici Maugeri
Respiratory Rehabilitation Division
Daniele Colombo, INRCA - Istituto Nazionale Riposo e Cura Anziani, Unità di Terapia Intensiva Intermedia Respiratoria

 Unità di Terapia Intensiva Intermedia Respiratoria (UTIIR)

Olivia Leoni, Regione Lombardia
Programmazione Polo Ospedaliero Struttura Farmaco, Dispositivi e HTA, Farmacovigilanza, Direzione Generale Welfare
Enrico Guffanti, INRCA - Istituto Nazionale Riposo e Cura Anziani, UO Pneumologia Riabilitativa
UO Pneumologia Riabilitativa

How to Cite

Vitacca, Michele, Luca Barbano, Daniele Colombo, Olivia Leoni, and Enrico Guffanti. 2018. “Prevalence and Variability of Use of Home Mechanical Ventilators, Positive Airway Pressure and Oxygen Devices in the Lombardy Region, Italy”. Monaldi Archives for Chest Disease 88 (1).