Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme.
BACKGROUND
Pulmonary rehabilitation programmes improve the health of patients disabled by lung disease but their cost effectiveness is unproved. We undertook a cost/utility analysis in conjunction with a randomised controlled clinical trial of pulmonary rehabilitation versus standard care.


METHODS
Two hundred patients, mainly with chronic obstructive pulmonary disease, were randomly assigned to either an 18 visit, 6 week rehabilitation programme or standard medical management. The difference between the mean cost of 12 months of care for patients in the rehabilitation and control groups (incremental cost) and the difference between the two groups in quality adjusted life years (QALYs) gained (incremental utility) were determined. The ratio between incremental cost and utility (incremental cost/utility ratio) was calculated.


RESULTS
Each rehabilitation programme for up to 20 patients cost pound 12,120. The mean incremental cost of adding rehabilitation to standard care was pound -152 (95% CI -881 to 577) per patient, p=NS. The incremental utility of adding rehabilitation was 0.030 (95% CI 0.002 to 0.058) QALYs per patient, p=0.03. The point estimate of the incremental cost/utility ratio was therefore negative. The bootstrapping technique was used to model the distribution of cost/utility estimates possible from the data. A high likelihood of generating QALYs at negative or relatively low cost was indicated. The probability of the cost per QALY generated being below pound 0 was 0.64.


CONCLUSIONS
This outpatient pulmonary rehabilitation programme produces cost per QALY ratios within bounds considered to be cost effective and is likely to result in financial benefits to the health service.
Griffiths
T L
TL
Section of Respiratory Medicine, Department of Medicine, University of Wales College of Medicine, Llandough Hospital, Penarth, Vale of Glamorgan CF64 2XX, UK. griffithstl@cardiff.ac.uk
Phillips
C J
CJ
Davies
S
S
Burr
M L
ML
Campbell
I A
IA
D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000188:drug therapy / Q000534:rehabilitation*; D018803:Models, Economic; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years; D014195:Travel