Effectiveness and Efficiency of Home Telemonitoring and Non-invasive Ventilation in Patients With COPD and Hypercapnia (EVALECO) (EVALECO)

Effectiveness and Efficiency of Home Telemonitoring and Non-invasive Ventilation in Patients With COPD and Hypercapnia

The purpose of this study is to evaluate the effectiveness and clinical efficiency of combining home non-invasive ventilation (NIV) with a continuous remote telemonitoring (TM) system in patients with Chronic Obstructive Pulmonary Disease (COPD) and persistent hypercapnia. In standard practice, patients with severe COPD and high carbon dioxide levels in their blood are treated with home non-invasive ventilation to support their breathing. This study compares two different care strategies over a one-year follow-up period:

1. One group of patients will receive standard home non-invasive ventilation alone.
2. Another group will receive home non-invasive ventilation combined with an automated telemonitoring system that tracks device parameters daily (such as air leaks, device usage, and breathing rates) and sends automated alerts to the healthcare team if deviations occur. The main goal of the project is to determine if adding a telemonitoring follow-up system can prevent clinical worsenings and significantly reduce the total number of days patients spend hospitalized due to severe COPD flare-ups. Additionally, the study will analyze the impact of both strategies on patients' overall health-related quality of life and the economic costs within the healthcare system.

Study Overview

• Status: Not yet recruiting
• Conditions: Hypercapnia; Pulmonary Disease, Chronic Obstructive (COPD)
• Intervention / Treatment: Device: Home Non-Invasive Ventilation and Telemonitoring

Detailed Description

Background and Rationale:

Chronic Obstructive Pulmonary Disease (COPD) with persistent hypercapnia is associated with increased mortality, functional decline, and high healthcare costs. While home non-invasive ventilation (NIV) is established as standard care to correct chronic respiratory failure, integrating remote telemonitoring (TM) presents an opportunity to implement early clinical interventions by allowing continuous oversight of ventilator parameters.

Study Design and Setting:

This is a prospective, multicenter, comparative cohort study with an integrated economic and utility evaluation. The study will be conducted across 5 public university hospitals within the Community of Madrid, Spain. A total of 92 patients (46 patients in the NIV+TM cohort and 46 in the conventional NIV cohort).

Study Hypotheses:

• Conceptual Hypothesis: Patients managed with the combined NIV+TM strategy experience a better clinical course than those treated with standard NIV alone.
• Statistical Hypothesis: Patients in the NIV+TM group will experience a lower average burden of exacerbation-related hospitalizations (estimated average of 24 days over 12 months) compared to the conventional NIV group (estimated average of 32 days over 12 months), reflecting a significant reduction of 8 hospital days between both management strategies during the first year of treatment.

Description of Cohorts and Follow-up Interventions:

• Combined Ventilation and Telemonitoring Cohort (NIV+TM): Patients receive standard advanced pressure-controlled nocturnal NIV combined with a remote data transmission modem. Clinical parameters-including device compliance, residual Apnea-Hypopnea Index (AHI), intentional/unintentional air leaks, respiratory rate (RR), and tidal volume (Vt)-are continuously monitored. Automated alerts are prioritized by the system: Low Priority alerts are tracked during routine visits, while High Priority alerts trigger an explicit, standardized clinical decision algorithm. This algorithm mandates immediate telephone triage, home technician visits for equipment adjustments, or direct communication with the prescribing pulmonologist for parameter adjustments. Domiciliary visits and health-related quality of life assessments (EQ-5D-5L and Severe Respiratory Insufficiency [SRI] questionnaires) will be carried out at baseline, 30, 90, 180, 270, and 365 days.
• Conventional Ventilation Cohort (NIV alone):

Patients receive identical advanced pressure-controlled nocturnal NIV settings but without remote data monitoring capabilities. Follow-up follows conventional guidelines based on standard clinical dependence: monthly home visits for patients requiring >12 hours/day of ventilation, or quarterly home visits for those requiring ≤12 hours/day. Compliance data, air leaks, and adaptation are checked manually during these visits. In-person follow-ups, EQ-5D-5L, and SRI assessments occur at baseline, day 30, and regular domiciliary visits, alongside mandatory arterial blood gas monitoring at 3, 6, and 12 months to verify treatment efficacy.

Economic and Data Analysis:

Analytical evaluations will be performed on an intention-to-treat basis. Clinical outcomes, utility values (Quality-Adjusted Life Years - QALYs gained calculated via Spanish EQ-5D-5L utility weights), and direct medical/non-medical healthcare system costs (utilizing the most recent official public tariffs from the Madrid Health Service - SERMAS) will be combined. Incremental Cost-Effectiveness Ratios (ICER), Incremental Cost-Utility Ratios (ICUR), and Incremental Cost-Benefit ratios will be constructed to evaluate healthcare efficiency. Uncertainty will be addressed via a deterministic sensitivity analysis assessing baseline, best-case, and worst-case scenarios for the telemonitoring implementation.

We have updated the Study Description to remove the term 'randomly allocated' to avoid misunderstanding. This is a strictly observational study where participants receive interventions (NIV or NIV+TM) as part of routine medical care based on institutional availability and clinical criteria, not by investigator assignment. To minimize selection bias inherent to the observational nature of the study, a consecutive sampling methodology and a post-hoc matching or adjusted statistical analysis using a block-restrictive system based on clinical variables was utilized, ensuring the investigator does not prospectively assign interventions.

• Study Type: Observational
• Enrollment (Estimated): 92

Contacts and Locations

• Study Contact: Name: Daniel López Padilla, MD, PhD; Phone Number: 91 586 83 28; Email: danieleduardo.lopez@salud.madrid.org

Study Locations

• Spain
  • Madrid
    • Madrid, Madrid, Spain, 28007
      • Hospital General Universitario Gregorio Marañon
      • Contact: Daniel López Padilla, MD, PhD; Phone Number: 91 586 83 28; Email: danieleduardo.lopez@salud.madrid.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The study population consists of adult patients diagnosed with severe, stable Chronic Obstructive Pulmonary Disease (COPD) and chronic persistent hypercapnia, who are managed and followed at public university hospitals within the Community of Madrid, Spain, and who have a recent history of frequent acute respiratory exacerbations.

Description

Inclusion Criteria:

1. Age between 50 and 90 years.
2. Confirmed diagnosis of Chronic Obstructive Pulmonary Disease (COPD) according to current Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, demonstrating non-fully reversible airflow limitation with a Forced Expiratory Volume in 1 second (FEV1) < 50% of the predicted value confirmed by spirometry.
3. Persistent hypercapnia, defined as PaCO2 > 53 mmHg documented for at least two weeks following an acute COPD exacerbation.
4. History of two or more acute COPD exacerbations within the preceding year.
5. Signed written informed consent.

Exclusion Criteria:

1. Prior ongoing treatment with home non-invasive ventilation (NIV) or Continuous Positive Airway Pressure (CPAP).
2. Severe obstructive sleep apnea (OSA), defined as an Apnea-Hypopnea Index (AHI) >= 30.
3. Inability of the patient or the primary caregiver to comprehend or operate the telemonitoring and NIV procedures.
4. Estimated life expectancy of less than one year.
5. Terminal heart failure (New York Heart Association [NYHA] Class III-IV) or unstable angina.
6. Advanced renal insufficiency (creatinine clearance < 30%) or inclusion in an active dialysis program.
7. Hepatic cirrhosis or active inclusion in a liver transplant program.
8. Severe psychiatric illness requiring antipsychotic medication, active ongoing treatment for substance or alcohol addiction, or lack of a fixed home address upon hospital discharge.
9. Receipt of home palliative care.
10. Institutionalization.
11. Classification by the attending physician as non-compliant with medical therapies, treatments, or study protocols

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
NIV+TM Cohort; Patients managed with a combined strategy consisting of advanced pressure-controlled nocturnal home non-invasive ventilation (NIV) and continuous remote telemonitoring (TM). Device compliance, residual Apnea-Hypopnea Index (AHI), air leaks, respiratory rate, and tidal volume are monitored daily. High-priority automated alerts trigger a standardized clinical decision algorithm, requiring immediate telephone triage or parameter modifications.	Device: Home Non-Invasive Ventilation and Telemonitoring; Use of nocturnal home non-invasive ventilation devices equipped with or without integrated digital modems for automated parameter monitoring (compliance, leaks, residual AHI, respiratory rate, and tidal volume) over a 12-month follow-up period.
Conventional NIV Cohort; Patients managed with conventional home non-invasive ventilation (NIV) following standard follow-up guidelines based on clinical dependence, without remote telemonitoring or automatic alert systems. Compliance and leak data are verified manually during scheduled domiciliary visits (monthly or quarterly depending on daily ventilation hours).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of prevented days of hospitalization due to COPD acute exacerbations	The total number of days a patient spends hospitalized in a general hospital ward or Intensive Care Unit (ICU) due to acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD). An acute exacerbation is defined according to GOLD criteria as an increase in dyspnea, cough, and/or sputum worsening in less than 14 days.	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health-Related Quality of Life and Utility (QALYs)	Measured using the validated Spanish version of the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire. It evaluates 2 continuous components: the Visual Analogue Scale (VAS, scored 0-100) and the EQ-Index (scored 0-1, where 1 represents perfect health and 0 represents death). These scores will be utilized to calculate Quality-Adjusted Life Years (QALYs) gained.	Baseline, 30 days, 90 days, 180 days, 270 days, and 365 days.
Number of Acute COPD Exacerbations	Total count of localized respiratory worsening events matching the GOLD definition (worsening of dyspnea, cough, or sputum) experienced by patients during the study.	12 months
Number of Hospital Admissions due to COPD Exacerbations	Total number of formal hospital admissions required due to severe acute respiratory deteriorations.	12 months
Number of Emergency Department Visit	Total count of unexpected visits to hospital emergency rooms or primary care emergency facilities necessitated by acute COPD flare-ups.	12 months
Time to first acute COPD exacerbation	The specific time period (measured in days) elapsed from the baseline treatment initiation until the documentation of the patient's first acute COPD exacerbation event.	Up to 12 months
Direct Healthcare Costs	Total direct medical and non-medical healthcare resources consumed per patient (including non-invasive ventilation service costs, telemonitoring setup, emergency visits, and hospitalization days in regular wards or ICU), calculated by applying official public healthcare tariffs from the Madrid Health Service (SERMAS).	12 months

Collaborators and Investigators

• Sponsor: Air Liquide Healthcare Spain

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: June 23, 2026
• First Submitted That Met QC Criteria: June 29, 2026
• First Posted (Actual): July 1, 2026

Study Record Updates

• Last Update Posted (Actual): July 1, 2026
• Last Update Submitted That Met QC Criteria: June 29, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Telemonitoring; Respiratory Insufficiency; Home Noninvasive Ventilation
• Additional Relevant MeSH Terms: Pathologic Processes; Chronic Disease; Disease Attributes; Respiratory Tract Diseases; Respiration Disorders; Lung Diseases, Obstructive; Signs and Symptoms, Respiratory; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Lung Diseases; Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency; Hypercapnia
• Other Study ID Numbers: EVALECO-TM+VNID-EPOC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared externally due to strict patient confidentiality, data privacy, and legal regulations. In compliance with Spanish Organic Law 3/2018 (GDPR implementation) and the Patient Autonomy Law 41/2002, the link between patient identity and their study code is exclusively known and held by their attending physician[cite: 660, 685, 690, 691]. All clinical data collected are managed within a closed, pseudonymized centralized electronic platform (ReseaArch®) under a strict role-based access control architecture. External distribution of raw individual datasets is neither covered by the patient informed consent nor approved by the participating institutional ethics committees.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No