title: Cost-effectiveness of integrated COPD care: the RECODE cluster randomised trial.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of a chronic obstructive pulmonary disease (COPD) disease management (COPD-DM) programme in primary care, called RECODE, compared to usual care.
  
  
  METHODS
  A 2-year cluster-randomised controlled trial.
  
  
  METHODS
  40 general practices in the western part of the Netherlands.
  
  
  METHODS
  1086 patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team.
  
  
  METHODS
  A multidisciplinary team of caregivers was trained in motivational interviewing, setting up individual care plans, exacerbation management, implementing clinical guidelines and redesigning the care process. In addition, clinical decision-making was supported by feedback reports provided by an ICT programme.
  
  
  METHODS
  We investigated the impact on health outcomes (quality-adjusted life years (QALYs), Clinical COPD Questionnaire, St. George's Respiratory Questionnaire and exacerbations) and costs (healthcare and societal perspective).
  
  
  RESULTS
  The intervention costs were €324 per patient. Excluding these costs, the intervention group had €584 (95% CI €86 to €1046) higher healthcare costs than did the usual care group and €645 (95% CI €28 to €1190) higher costs from the societal perspective. Health outcomes were similar in both groups, except for 0.04 (95% CI -0.07 to -0.01) less QALYs in the intervention group.
  
  
  CONCLUSIONS
  This integrated care programme for patients with COPD that mainly included professionally directed interventions was not cost-effective in primary care.
  
  
  BACKGROUND
  Netherlands Trial Register NTR2268.
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Melinde R S
authors.initials: MR
authors.lastname: Boland
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Annemarije L
authors.initials: AL
authors.lastname: Kruis
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsiachristas
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
authors.affiliation: Stichting Zorgdraad foundation, Oosterbeek, The Netherlands.
authors.forename: Coert M G
authors.initials: CM
authors.lastname: Blom
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Chavannes
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Maureen P M H
authors.initials: MP
authors.lastname: Rutten-van Mölken
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D058006:General Practice; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D009426:Netherlands; D010348:Patient Care Team / Q000191:economics; D011320:Primary Health Care / Q000191:economics; D015397:Program Evaluation / Q000191:economics; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires
keywords: HEALTH ECONOMICS; PRIMARY CARE; RESPIRATORY MEDICINE (see Thoracic Medicine)