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Title: Home-based pulmonary rehabilitation for COPD using minimal resources: An economic analysis.
Austin Authors: 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
Affiliation: Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
Discipline of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
Issue Date: Feb-2020 2019-08-16
Publication information: Respirology 2020; 25(2): 183-190
Abstract: 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.
DOI: 10.1111/resp.13667
ORCID: 0000-0001-5455-6467
PubMed URL: 31418515
Type: Journal Article
Subjects: chronic obstructive pulmonary disease
cost-benefit analysis
exercise therapy
healthcare costs
quality-adjusted life years
Appears in Collections:Journal articles

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