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.
journal_name
Appl Health Econ Health Policyjournal_title
Applied health economics and health policyauthors
Burns DK,Wilson EC,Browne P,Olive S,Clark A,Galey P,Dix E,Woodhouse H,Robinson S,Wilson Adoi
10.1007/s40258-015-0199-9subject
Has Abstractpub_date
2016-02-01 00:00:00pages
105-15issue
1eissn
1175-5652issn
1179-1896pii
10.1007/s40258-015-0199-9journal_volume
14pub_type
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journal_title:Applied health economics and health policy
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