The Vest™ High-Frequency Chest Wall Oscillation System Compared with Manual Chest Wall Physiotherapy for Managing Airway Clearance in Patients with Complex Neurological Disorders: A UK-based Cost-Effectiveness Analysis

Mehdi Javanbakht1, *, Atefeh Mashayekhi1, Mohammad Montazeri2, Mohsen Rezai Hemami3, Michael Branagan-Harris4
1 Health Economics Group, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
2 Optimax Access UK Ltd, Market Access Consultancy, Southampton, UK
3 PenTAG Health Technology Assessment, University of Exeter, Exeter, UK
4 Device Access UK Ltd, Market Access Consultancy, University of Southampton Science Park, Chilworth Hampshire, UK

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© 2019 Javanbakht et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Health Economics Group, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK;
Tel: 004475646456414;



Weakness in the muscles used to breathe and swallow can lead to difficulties with airway clearance for people with neurological disorders including neuromuscular disease and cerebral palsy. This can lead to aspiration and other respiratory problems which are the leading causes of death in patients with complex neurological disorders. The Vest™ system supports airway clearance through the use of High-Frequency Chest Wall Oscillation (HFCWO) to loosen secretions in the chest by reducing their viscosity.


To assess the cost-effectiveness of the Vest™ system versus Manual Chest Wall Physiotherapy (MCWP) for airway clearance in patients with neurological disorders including neuromuscular disease and cerebral palsy.


A decision-analytic Markov model was developed to estimate the cost-effectiveness of HFCWO and MCWP over 5- and 10-year time horizons. Costs were estimated from the perspective of the UK National Health Service and personal social services. The main input parameters in the model were: rates of respiratory infection, respiratory-related hospitalisation, antibiotic use for respiratory infection and cost of the Vest™ system. The input parameters were informed by existing clinical guidelines and literature. Sensitivity analyses were conducted to explore uncertainties around the input parameters.


Over 5- and 10-year time horizons, the Vest™ system results in more quality-adjusted life-years and lower costs per patient. The Vest™ system has a high probability of being cost-effective (>98%) at willingness-to-pay thresholds of £20,000 and £30,000. The estimated average cost saving per patient over a 5-year time horizon is £5,660 (SD = £2362). Our results show that the Vest™ system may result in approximately £6 million cost savings per 1,000 patients with complex neurological disorders in 5 years. Per 1,000 patients, 2,442 hospital admissions and 49,868 bed days could be averted with the use of the Vest™ system. Our results were generally robust to the sensitivity analyses performed.


The Vest™ system results in fewer respiratory infection episodes and hospitalisations, and thus less National Health Service (NHS) resource use, than current practice. Therefore, it is highly likely to be a cost-saving strategy.

Keywords: High-frequency chest wall oscillation, The Vest™ system, Neuromuscular disease, Cerebral palsy, Cost-effectiveness analysis, Respiratory infection.