Economic analysis of using home mechanical ventilation for children with neuromuscular weakness: the case study from Thailand.

Neuromuscular Weakness (NMW) is a chronic condition often leading to respiratory failure and the need for long-term ventilatory support. While Home Mechanical Ventilation (HMV) is an alternative to hospital-based mechanical ventilation (MV), its economic impact remains unclear. This study evaluated the economic and clinical impact of switching from hospital-based MV to HMV for Thai children requiring long-term ventilation, based on SMA Type II. A Markov model was developed to estimate lifetime costs and quality-adjusted life years (QALYs) from a societal perspective. Survival transition probabilities were derived from Thai pediatric SMA Type II data, with other parameters obtained from the literature and expert consultation. Cost parameters were sourced from Thailand's Health Technology Assessment database. HMV was the dominant strategy, reducing total lifetime costs from $308,179 (hospital-based MV) to $120,270-a saving of $187,909 per patient-while increasing QALYs from 2.52 to 4.33 (an incremental gain of 1.81 QALYs and 2.32 life-years). The savings arose primarily from avoiding prolonged inpatient care. HMV remained dominant across all deterministic and probabilistic sensitivity analyses. In a resource-constrained health system, HMV reduced costs while improving outcomes. A reimbursement pathway for HMV could be developed in line with the country's readiness and capacity, with support for hospitals strengthened to sustain home-based ventilation.