Is INTERdisciplinary COMmunity-based COPD management (INTERCOM) cost-effective?

M. Hoogendoorn, C.R. van Wetering, A.M. Schols, M.P.M.H. Rutten-van Mölken

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Abstract

The study aimed to estimate the cost-effectiveness of interdisciplinary community-based COPD management in patients with COPD.We conducted a cost-effectiveness analysis alongside a two-year randomized controlled trial, in which 199 patients with less advanced airflow obstruction and impaired exercise capacity were assigned to the INTERCOM program or usual care. The INTERCOM program consisted of exercise training, education, nutritional therapy and smoking cessation counselling offered by community-based physiotherapists and dieticians and hospital-based respiratory nurses. Two-year all-cause resource use was obtained by self-report and from hospital and pharmacy records. Health outcomes were the St. George's-Respiratory-Questionnaire (SGRQ), exacerbations and Quality-Adjusted Life Years (QALYs).The INTERCOM group had 30% (95%CI:3-56%) more patients with a clinically relevant improvement in SGRQ total score, 0.08 (95%CI:-0.01-0.18) more QALYs per patient, but a higher mean number of exacerbations, 0.84 (95%CI:-0.07-1.78). Mean total two-year costs were euro2,751 (95%CI:-632-6,372) higher for INTERCOM than for usual care, which resulted in an incremental cost-effectiveness ratio of euro9,078 per additional patient with a relevant improvement in SGRQ or euro32,425 per QALY.INTERCOM significantly improved disease-specific quality of life, but did not affect exacerbation rate. The cost per QALY ratio was moderate, but within the range of what is generally considered to be acceptable.
Original languageEnglish
Pages (from-to)79-87
Number of pages9
JournalEuropean Respiratory Journal
Volume35
Issue number1
DOIs
Publication statusPublished - 1 Jan 2010

Keywords

  • Chronic obstructive pulmonary disease
  • community-based
  • cost-effectiveness
  • pulmonary rehabilitation
  • quality-adjusted life years
  • OBSTRUCTIVE PULMONARY-DISEASE
  • QUALITY-OF-LIFE
  • OUTPATIENT REHABILITATION
  • RANDOMIZED-TRIAL
  • SELF-MANAGEMENT
  • PROGRAM
  • ALONGSIDE
  • EUROQOL

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