The Cost Effectiveness of Maintenance Schedules Following Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: An Economic Evaluation Alongside a Randomised Controlled Trial.


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Authors
Burns, Darren K 
Wilson, Edward CF 
Browne, Paula 
Olive, Sandra 
Clark, Allan 
Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects approximately 3 million people in the UK. An 8-week pulmonary rehabilitation (PR) course is recommended under current guidelines. However, studies show that initial benefits diminish over time. OBJECTIVE: We present here an economic evaluation conducted alongside a randomised controlled trial (RCT) of a low-intensity maintenance programme over a time horizon of 1 year delivered in UK primary and secondary care settings. METHODS: Patients with COPD who completed at least 60 % of a standard 8-week PR programme were randomised to a 2-h maintenance session at 3, 6 and 9 months (n = 73) or treatment as usual (n = 75). Outcomes were change in Chronic Respiratory Questionnaire (CRQ) score, EQ-5D-based QALYs, cost (price year 2014) to the UK NHS and social services over the 12 months following initial PR, and incremental cost-effectiveness ratios (ICERs). RESULTS: At 12 months, incremental cost to the NHS and social services was -£204.04 (95 % CI -£1522 to £1114). Incremental CRQ and QALY gains were -0.007 (-0.461 to 0.447) and +0.015 (-0.050 to 0.079), respectively. Based on point estimates, PR maintenance therefore dominates treatment as usual from the perspective of the NHS and social services in terms of cost per QALY gained. Whether it is cost effective in terms of CRQ depends on whether the £204 per patient could be reinvested elsewhere to a CRQ gain of greater than 0.007. However, there is much decision uncertainty: 95 % CIs around increments did not exclude zero, and there is a 72.9 % (72.5 %) probability that the ICER is below £20,000 (£30,000) per QALY. CONCLUSION: Future research should explore whether more intensive maintenance regimens offer benefit to patients at reasonable cost.

Description
Keywords
Aged, Cost-Benefit Analysis, Female, Health Care Costs, Humans, Male, Pulmonary Disease, Chronic Obstructive, Quality-Adjusted Life Years, State Medicine, Time Factors, United Kingdom
Journal Title
Appl Health Econ Health Policy
Conference Name
Journal ISSN
1175-5652
1179-1896
Volume Title
14
Publisher
Springer Science and Business Media LLC
Sponsorship
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0408-16225).