title: Economic evaluation of a comprehensive self-management programme in patients with moderate to severe chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  The main objective of this study was to investigate whether a comprehensive self-management programme, including self-treatment guidelines for exacerbations and a fitness programme, is an efficient treatment option for chronic obstructive pulmonary disease (COPD) patients.
  
  
  METHODS
  We randomly allocated 248 COPD patients to either self-management (127) or usual care (121). Data on preference-based utilities (EuroQol-5D), health-related quality of life (HRQoL), health-care resource use and productivity losses associated with exacerbations were prospectively collected. Quality-adjusted life years (QALYs) were calculated. The economic analysis took the societal perspective and the observation period was one year.
  
  
  RESULTS
  As we observed that the groups were equally effective in terms of QALYs and HRQoL (SGRQ), we described a cost minimization analysis only. The self-management programme-specific costs amounted to Euro 642 per patient. In the base-case cost analysis, the incremental cost difference amounted to Euro 838 per patient per year in favour of usual care. When only direct medical costs were included, the incremental annual cost of self-management relative to usual care was Euro 179 per person per year. If time costs for the fitness programme were set to zero, the costs for self-management diminished to Euro 542. Sensitivity analysis showed that these results were robust to changes in the underlying assumptions.
  
  
  CONCLUSIONS
  We conclude that the COPE self-management programme is not an efficient treatment option for moderate to severe COPD patients who rate their HRQoL relatively high. The programme was twice as expensive as usual care and had no measurable beneficial effects on QALYs or HRQoL.
authors.affiliation: Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Monninkhof
authors.forename: P
authors.initials: P
authors.lastname: van der Valk
authors.forename: T
authors.initials: T
authors.lastname: Schermer
authors.forename: J
authors.initials: J
authors.lastname: van der Palen
authors.forename: C
authors.initials: C
authors.lastname: van Herwaarden
authors.forename: G
authors.initials: G
authors.lastname: Zielhuis
mesh_terms: D000328:Adult; D000368:Aged; D003191:Comprehensive Health Care / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D015397:Program Evaluation / Q000191:economics*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000628:therapy*; D012648:Self Care / Q000191:economics*; D012720:Severity of Illness Index; D016896:Treatment Outcome