Home-based pulmonary rehabilitation for COPD using minimal resources: An economic analysis.

2020-02

Burge, Angela T

Holland, Anne E

McDonald, Christine F

Abramson, Michael J

Hill, Catherine J

Lee, Annemarie L

Cox, Narelle S

Moore, Rosemary P

Nicolson, Caroline

O'Halloran, Paul

Lahham, Aroub

Gillies, Rebecca

Mahal, Ajay

chronic obstructive pulmonary disease

cost-benefit analysis

exercise therapy

healthcare costs

quality-adjusted life years

Journal Article

0000-0001-5455-6467

0000-0003-2061-845X

0000-0001-6481-3391

0000-0002-9954-0538

0000-0003-2090-0746

0000-0002-5092-4370

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#PLACEHOLDER_PARENT_METADATA_VALUE#

#PLACEHOLDER_PARENT_METADATA_VALUE#

#PLACEHOLDER_PARENT_METADATA_VALUE#

#PLACEHOLDER_PARENT_METADATA_VALUE#

#PLACEHOLDER_PARENT_METADATA_VALUE#

10.1111/resp.13667

This study aimed to compare the cost-effectiveness and cost-utility of home and centre-based pulmonary rehabilitation for adults with stable chronic obstructive pulmonary disease (COPD). Prospective economic analyses were undertaken from a health system perspective alongside a randomized controlled equivalence trial in which participants referred to pulmonary rehabilitation undertook a standard 8-week outpatient centre-based or a new home-based programme. Participants underwent clinical assessment prior to programme commencement, immediately following completion and 12 months following programme completion. They provided data for utility (quality-adjusted life years (QALY) determined using SF6D (utility scores for health states) calculated from 36-Item Short Form Health Survey version 2) and effectiveness (change in distance walked on 6-min walk test (Δ6MWD) following pulmonary rehabilitation ). Individual-level cost data for the 12 months following programme completion was sourced from healthcare administration and government databases. Between-group mean difference point estimates for cost (-$4497 (95% CI: -$12 250 to $3257), utility (0.025 (-0.038 to 0.086) QALY) and effectiveness (14 m (-11 to 39) Δ6MWD) favoured the home-based group. Cost-utility analyses demonstrated 63% of estimates falling in the dominant southeast quadrant and the probability that the new home-based model was cost-effective at a $0 threshold for willingness to pay was 78%. Results were robust to a range of sensitivity analyses. Programme completion was associated with significantly lower healthcare costs in the following 12 months. Home-based pulmonary rehabilitation provides a cost-effective alternative model for people with COPD who cannot access traditional centre-based programmes.

link

Respirology 2020; 25(2): 183-190

Respirology