title: Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management.
abstract: BACKGROUND
  Information regarding cost-effectiveness of community-based exercise programmes in COPD is scarce. Therefore, we have investigated whether a community-based exercise programme is a cost-effective component of self-management for patients with COPD after 2 years of follow-up.
  
  
  METHODS
  All included COPD patients participated in four self-management sessions. Additionally, patients in the COPE-active group participated in an 11-month community-based exercise programme led by physiotherapists. Patients trained 3 times/week for 6 months and two times/week during the subsequent 5 months. In both periods, one of these weekly training sessions was home-based (unsupervised). No formal physiotherapy sessions were offered to COPE-active patients in the second year. A decision analytical model with a 24-month perspective was used to evaluate cost-effectiveness. Incremental cost-effectiveness ratios (ICER) were calculated and cost-effectiveness planes were created.
  
  
  RESULTS
  Data of 77 patients participating in the exercise programme and 76 patients in the control group were analysed. The ICER for an additional patient prevented from deteriorating at least 47.5 meters on the ISWT was €6257. The ICER for an additional patient with a clinically relevant improvement (≥ 500 steps/day) in physical activity was €1564, and the ICER for an additional quality-adjusted life year (QALY) was €10 950.
  
  
  CONCLUSIONS
  Due to a lack of maintenance of beneficial effects on our primary outcome exercise capacity after 2 years of follow-up and higher costs of the programme, the community-based exercise programme cannot be considered cost-effective compared to self-management programmes only. Nevertheless, the ICERs for the secondary outcomes physical activity and QALY are generally considered acceptable.
authors.affiliation: a 1 Medisch Spectrum Twente , Department of Pulmonary Medicine , Enschede , the Netherlands.
authors.forename: Marlies
authors.initials: M
authors.lastname: Zwerink
authors.affiliation: b 2 Southern Adelaide Local Health Network, Repatriation General Hospital, Respiratory Research Unit , Daw Park , South Australia , Australia.|c 3 Flinders University, School of Medicine , Adelaide , South Australia , Australia.
authors.forename: Tanja
authors.initials: T
authors.lastname: Effing
authors.affiliation: d 4 University of Groningen and University Medical Center Groningen , Department of Pulmonology , Groningen , the Netherlands.
authors.forename: Huib A M
authors.initials: HA
authors.lastname: Kerstjens
authors.affiliation: a 1 Medisch Spectrum Twente , Department of Pulmonary Medicine , Enschede , the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: van der Valk
authors.affiliation: a 1 Medisch Spectrum Twente , Department of Pulmonary Medicine , Enschede , the Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Brusse-Keizer
authors.affiliation: e 5 Radboud University Medical Center , Department for Health Evidence , Nijmegen , the Netherlands.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Zielhuis
authors.affiliation: a 1 Medisch Spectrum Twente , Department of Pulmonary Medicine , Enschede , the Netherlands.|f 6 University Twente , Department of Research Methodology, Measurement and Data Analysis , Enschede , the Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
mesh_terms: D003362:Cost-Benefit Analysis; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012648:Self Care / Q000191:economics*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: COPD; community-based; cost-effectiveness; exercise; physical activity; self-management