Oscillating positive expiratory pressure devices for airway clearance in chronic hypersecretory lung conditions

Health Technology Wales
Record ID 32018001465
Authors' objectives: HTW undertook an evidence review to address the following question: are oscillating positive expiratory pressure (OPEP) devices more clinically and cost-effective than other techniques for airway clearance in chronic hypersecretory lung conditions?
Authors' results and conclusions: A significant amount of evidence was identified on the effectiveness of OPEP in a range of different type of hypersecretory lung conditions. The evidence available centres mainly around their use in cystic fibrosis, bronchiectasis and chronic obstructive pulmonary disease (COPD). The way in which OPEP devices were used, and what outcomes were used to measure their effectiveness, differed considerably between different sources of evidence. Change in lung function measures are regularly reported for each condition but rarely identified a benefit for OPEP over their comparator. The evidence found suggests that there is no benefit to health-related quality of life between interventions in cystic fibrosis patients and only in comparison to no other airway clearance techniques in bronchiectasis patients. Findings for other outcomes were mixed. There was a lack of studies comparing different OPEP devices but where these existed, they did not find significant differences in outcomes for cystic fibrosis patients, and reported mixed findings for bronchiectasis patients. A resource impact analysis has been developed but was limited to the use of Aerobika in COPD patients where there was economic evidence available. Assuming 50% of patients with severe COPD are prescribed a device, and using the average cost of all OPEP devices, the net cost of introducing OPEP to the COPD patient population in Wales over five years could be estimated at £0.76 million. Given the limited data available to base the analysis on, these results are subject to considerable uncertainty.
Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.
Project Status: Completed
Year Published: 2021
English language abstract: An English language summary is available
Publication Type: Rapid Review
Country: Wales, United Kingdom
MeSH Terms
  • Positive-Pressure Respiration
  • Respiratory Therapy
  • Chest Wall Oscillation
  • Cystic Fibrosis
  • Bronchiectasis
  • Pulmonary Disease, Chronic Obstructive
  • Lung Diseases, Obstructive
  • OPEP
  • oscillating positive expiratory pressure
  • bronchiestasis
  • COPD
  • chronic obstructive pulmonary disease
  • cystic fibrosis
  • airway clearance techniques
Organisation Name: Health Technology Wales
Contact Address: Life Sciences Hub Wales 3 Assembly Square Cardiff CF10 4PL
Contact Name: Susan Myles, PhD
Contact Email: healthtechnology@wales.nhs.uk
Copyright: Health Technology Wales
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.