title: Economic evaluation of a disease management program for chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The data on cost savings with disease management (DM) in chronic obstructive pulmonary disease (COPD) is limited. A multicomponent DM program in COPD has recently shown in a large randomized controlled trial to reduce hospitalizations and emergency department visits compared to usual care (UC). The objectives of this study were to determine the cost of implementing the DM program and its impact on healthcare resource utilization costs compared to UC in high-risk COPD patients.
  
  
  METHODS
  This study was a post-hoc economic analysis of a multicenter randomized, adjudicator-blinded, controlled, 1-year trial comparing DM and UC at 5 Midwest region Department of Veterans Affairs (VA) medical centers. Health-care costs (hospitalizations, ED visits, respiratory medications, and the cost of the DM intervention) were compared in the COPD DM intervention and UC groups.
  
  
  RESULTS
  The composite outcome for all hospitalizations or ED visits were 27% lower in the DM group (123.8 mean events per 100 patient-years) compared to the UC group (170.5 mean events per 100 patient-years) (rate ratio 0.73; 0.56-0.90; p < 0.003). The cost of the DM intervention was $241,620 or $650 per patient. The total mean ± SD per patient cost that included the cost of DM in the DM group was 4491 ± 4678 compared to $5084 ± 5060 representing a $593 per patient cost savings for the DM program.
  
  
  CONCLUSIONS
  The DM intervention program in this study was unique for producing an average cost savings of $593 per patient after paying for the cost of DM intervention.
authors.affiliation: Pulmonary Section, Department of Medicine, VA Medical Center, Omaha, Nebraska 68105, USA. ndewan@creighton.edu
authors.forename: Naresh A
authors.initials: NA
authors.lastname: Dewan
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Rice
authors.forename: Michael
authors.initials: M
authors.lastname: Caldwell
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Hilleman
mesh_terms: D017046:Cost Savings; D003365:Costs and Cost Analysis; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs