The Cost Effectiveness of Maintenance Schedules Following Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: An Economic Evaluation Alongside a Randomised Controlled Trial.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) affects approximately 3 million people in the UK. An 8-week pulmonary rehabilitation (PR) course is recommended under current guidelines. However, studies show that initial benefits diminish over time.


OBJECTIVE
We present here an economic evaluation conducted alongside a randomised controlled trial (RCT) of a low-intensity maintenance programme over a time horizon of 1 year delivered in UK primary and secondary care settings.


METHODS
Patients with COPD who completed at least 60 % of a standard 8-week PR programme were randomised to a 2-h maintenance session at 3, 6 and 9 months (n = 73) or treatment as usual (n = 75). Outcomes were change in Chronic Respiratory Questionnaire (CRQ) score, EQ-5D-based QALYs, cost (price year 2014) to the UK NHS and social services over the 12 months following initial PR, and incremental cost-effectiveness ratios (ICERs).


RESULTS
At 12 months, incremental cost to the NHS and social services was -£204.04 (95 % CI -£1522 to £1114). Incremental CRQ and QALY gains were -0.007 (-0.461 to 0.447) and +0.015 (-0.050 to 0.079), respectively. Based on point estimates, PR maintenance therefore dominates treatment as usual from the perspective of the NHS and social services in terms of cost per QALY gained. Whether it is cost effective in terms of CRQ depends on whether the £204 per patient could be reinvested elsewhere to a CRQ gain of greater than 0.007. However, there is much decision uncertainty: 95 % CIs around increments did not exclude zero, and there is a 72.9 % (72.5 %) probability that the ICER is below £20,000 (£30,000) per QALY.


CONCLUSIONS
Future research should explore whether more intensive maintenance regimens offer benefit to patients at reasonable cost.
Health Economics Group, University of East Anglia, Norwich, NR4 7TJ, UK. darren.burns@uea.ac.uk.
Darren K
DK
Burns
Health Economics Group, University of East Anglia, Norwich, NR4 7TJ, UK.|Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
Edward C F
EC
Wilson
Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
Paula
P
Browne
Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
Sandra
S
Olive
Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
Allan
A
Clark
Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
Penny
P
Galey
Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
Emma
E
Dix
Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
Helene
H
Woodhouse
Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
Sue
S
Robinson
Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.|Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
Andrew
A
Wilson
D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000534:rehabilitation*; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics / Q000706:statistics & numerical data; D013997:Time Factors; D006113:United Kingdom