Telemonitoring of Long Term Oxygen Therapy: Air

Telemonitoring of Long Term Oxygen Therapy
in Chronic Obstructive Pulmonary Disesase:
Air Liquide Experience & Research
ESPACOM – LODZ – 09/17/2010
Marc Lemaire, MD
Health R&D Director
Revenues: € 12 billion
32%
9%
41%
18%
Electronics
Large Industries
Air gases and hydrogen
15-year contracts
Pipeline networks
Industrial basins
Industrial Merchant
Bulk and cylinder gases
75 countries
Wide variety of sectors and
customer sizes
Confidential
Carrier gases
Specialty gases
Equipment and
Installations
Healthcare
Hospitals
Homecare
Hygiene-Chemistry
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
2
Homecare Business
European Respiratory
Market
Sleep Apnoea Syndrom
Chronic Obstructive
Pulmonary Disease (COPD)
450 M€ (+18%)
750 M€ (+3%)
VitalAire:
MS ≈ 30%
C-PAP
L-TOT
(Continuous Positive Airways Pressure)
(Long-Term Oxygen Therapy)
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
3
Compliance Measurement of Long Term Oxygen Therapy
in Chronic Obstructive Pulmonary Disesase:
Why (how) do manage compliance ?
Social Security System (a: C-PAP)
Sleep Apneoa: the referenced disease
1. Definition: reduction or pause of breathing (airflow) during sleep
resulting in daytime sleepiness
2. Treatment: Continuous-Positive Airways Pressure
3. Measurement tool: Apnea-Hypopnea Index (AHI) defines severity
including sleep disruptions and desaturations
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
5
Social Security System (b: C-PAP Reimbursement)
Compliance measurement (AHI):
Initial assessment (5 months) then annual assessment
Reimbursement based on 3hrs/night
Manual download & (Tele)transmission by the technician
France: rental model => Advantages:
Cost-effectivement (payment related to patient treatment)
Full service (maintenance, 24hrs call center,
materiovigilance, mask adaptation, disposal, patient followup …)
material is never obsolete and can adapt to new prescription,
patient requirement, upgrade C-PAP…
Information flow
Responsibility: VitalAire
Sale vs Rental Model?
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
6
Social Security System (d: COPD)
- WW: 210 million COPD
- 2 million patients traited by L-TOT
- L-TOT survival curve + sleep & cognitive performance
- L-TOT hospitalisation days by - 43% due to an exacerbation
Hospitalization (days/year):
- France: 100,000 days
- USA: 673,000 days
ERS / ATS Recommendations
- Continuous administration (24h/jour) with deambulation.
- Education, training and follow-up (compliance) are essential to succeed
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
7
Social Security System (e: COPD)
L-TOT compliance measurement in COPD:
Technical issues: O2 sources from concentrators to liquid or
gaseous O2 with or without refilling system and on-demand
valve system
Patient issues: night & day, sitting, standing position, with or
without deambulation
Challenge: Device for CM has to be small, light & robust
(patient), suitable & efficient for all O2 sources and adapted
to all existing techno – autonomy
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
8
Physician Vision (a: COPD & L-TOT)
L-TOT is efficient for COPD
Continuous daily treatment
Min of 15 hrs/day => 24 hrs
Adapted to activity
L-TOT is more efficient
Trained patient
Coaching implementation
Medical survey for preventing exacerbations
DETECT EXACERBATION
EARLY HOMECARE TREATMENT
AVOIDING HOSPITALIZATION
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
9
Physician Vision (b: COPD & Exacerbation)
• COPD ECONOMIC BURDENS:
- Europe: 4% (€ 39 billion/yr) of global healthcare budget
- USA: 32 $ billion/yr
• Exacerbation: 70% of COPD cost & 1/10 hospital admission
• Exacerbation:
sustainedEquipment
worsening of the
condition from the stable state and
L-TOT
Ext. patient’s
Cst
DRUGS
beyong normal day-to-day
variations that is acute in onset and may additional treatment
• CONSEQUENCES: ↑ decline in lung function, mortality & ↓ quality of life
severity
Confidential
-
Jansson, Chest, 2002
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
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Physician Vision (c: Exacerbation & Early TTT)
N=128 patients
→Early treatment improves:
- recovery time
- quality of life
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
11
Physician Vision (c: Hospitalization & Management Program)
N=94 patients
Intervention: phone and home education + telephone support
Mean ± SEM
nb or nb of
days/patient
Farrero, Chest, 2001
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
12
Physician Vision (d: Hospitalization & Management Program)
N=94 patients
Intervention: phone and home education + telephone support
Objectives
⇓
x 2.6
1. Diagnose Early Exacerbation
2. Reduce Consequence for the patient x 3.75
3. Increase Survival
x 1.5
4. Improve QoL
Farrero, Chest, 2001
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
13
VitalAire Strategy (a: Objectives)
Supply the best solution at home (Patient)
Respect the prescription (MD)
Integrate Funded-Healthcare System expectations
R&D, proposing new solutions, new technologies, new
medical approaches… (Health Company)
⇓
Solution Provider for:
1) Physicians to diagnose as early as possible a risk of
exacerbation
2) Public SS to reduce total cost
3) Patients to improve QoL and reduce morbi-mortality
Confidential
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
14
VitalAire Strategy (b: strategy)
2009
O2 Patient
monitoring
O2
Confidential
Patient
education
& coaching
Clinical
Parameters
monitoring
ESPACOM – LODZ – 09/17/2010- Marc Lemaire
15
VitalAire Strategy (c: monitoring Objectives)
Develop and validate a monitoring device for oxygen therapy
A dedicated device to monitor patient adherence to LTOT:
→ Detects oxygen flow and patient breath
- Weight: 30 g
- Autonomy: 2 yr-battery
- Compatible with: Liquid oxygen / Concentrators / Gaseous oxygen
(13 different sources validated)
1. AL proprietary Device Development
e
n
Do
2. Validation for different oxygen sources
3. Validation trial for the use in patients
MedGas - SteerCom Hippocrate Homecare November 2009
16
VitalAire Vision (d: monitoring system)
Patient with COPD requiring new LTOT implementation assigned to the Intervention group
1. An educational program on COPD
Patient / Home
Daily symptom & O2
compliance recordings
2. Daily symptom transmission
Monitor center
Daily symptom
management
3. An early management
of clinical degradation
by the ‘respiratory team network’
Medical evaluation
Respiratory specialist
decision
Paramedical evaluation
Nurse visit at patient’s
home
MedGas - SteerCom Hippocrate Homecare November 2009
17
VitalAire Vision (e: future)
C-PAP Monitoring and TeleTransmission
L-TOT Monitoring and TeleTransmission:
• NOWOX + Daily Symptoms Management
=> patient compliance measurement
=> Early Exacerbation Detection
» Early Treament
» Avoid Hospitalization (patient life issue)
• Disease Cost Savings
MedGas - SteerCom Hippocrate Homecare November 2009
18
CONCLUSIONS (1)
What will be the strategy of the
« universal » health care systems?
At what level: National
or European?
MedGas - SteerCom Hippocrate Homecare November 2009
19
CONCLUSIONS (2)
STEP 1 => Efficacy / Safety Ratio
STEP 2 => Efficacy/Safety Ratio + Economical Evaluation
NEXT STEP =>
Efficacy / Safety Ratio
Economical Evaluation
Patient Compliance Measurement
⇓
Drugs & Services for Ambulatory Homecare Patients
MedGas - SteerCom Hippocrate Homecare November 2009
20
Telemonitoring of Long Term Oxygen Therapy
in Chronic Obstructive Pulmonary Disesase
ESPACOM – LODZ – 09/17/2010
THANKS
Marc Lemaire
Health R&D Director