title: The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial.
abstract: OBJECTIVE
  To assess the cost-effectiveness of a structured education pulmonary rehabilitation programme (SEPRP) for chronic obstructive pulmonary disease (COPD) relative to usual practice in primary care. The programme consisted of group-based sessions delivered jointly by practice nurses and physiotherapists over 8 weeks.
  
  
  METHODS
  Cost-effectiveness and cost-utility analysis alongside a cluster randomised controlled trial.
  
  
  METHODS
  32 general practices in Ireland.
  
  
  METHODS
  350 adults with COPD, 69% of whom were moderately affected.
  
  
  METHODS
  Intervention arm (n=178) received a 2 h group-based SEPRP session per week over 8 weeks delivered jointly by a practice nurse and physiotherapist at the practice surgery or nearby venue. The control arm (n=172) received the usual practice in primary care.
  
  
  METHODS
  Incremental costs, Chronic Respiratory Questionnaire (CRQ) scores, quality-adjusted life years (QALYs) gained estimated using the generic EQ5D instrument, and expected cost-effectiveness at 22 weeks trial follow-up.
  
  
  RESULTS
  The intervention was associated with an increase of €944 (95% CIs 489 to 1400) in mean healthcare cost and €261 (95% CIs 226 to 296) in mean patient cost. The intervention was associated with a mean improvement of 1.11 (95% CIs 0.35 to 1.87) in CRQ Total score and 0.002 (95% CIs -0.006 to 0.011) in QALYs gained. These translated into incremental cost-effectiveness ratios of €850 per unit increase in CRQ Total score and €472 000 per additional QALY gained. The probability of the intervention being cost-effective at respective threshold values of €5000, €15 000, €25 000, €35 000 and €45 000 was 0.980, 0.992, 0.994, 0.994 and 0.994 in the CRQ Total score analysis compared to 0.000, 0.001, 0.001, 0.003 and 0.007 in the QALYs gained analysis.
  
  
  CONCLUSIONS
  While analysis suggests that SEPRP was cost-effective if society is willing to pay at least €850 per one-point increase in disease-specific CRQ, no evidence exists when effectiveness was measured in QALYS gained.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN52 403 063.
authors.affiliation: School of Business and Economics, NUI Galway, Ireland.
authors.forename: Paddy
authors.initials: P
authors.lastname: Gillespie
authors.forename: Eamon
authors.initials: E
authors.lastname: O'Shea
authors.forename: Dympna
authors.initials: D
authors.lastname: Casey
authors.forename: Kathy
authors.initials: K
authors.lastname: Murphy
authors.forename: Declan
authors.initials: D
authors.lastname: Devane
authors.forename: Adeline
authors.initials: A
authors.lastname: Cooney
authors.forename: Lorraine
authors.initials: L
authors.lastname: Mee
authors.forename: Collette
authors.initials: C
authors.lastname: Kirwan
authors.forename: Bernard
authors.initials: B
authors.lastname: McCarthy
authors.forename: John
authors.initials: J
authors.lastname: Newell