title: (Cost-)effectiveness of self-treatment of exacerbations in patients with COPD: 2 years follow-up of a RCT.
abstract: OBJECTIVE
  Long-term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost-)effectiveness of a self-management programme with or without self-treatment of exacerbations after 2 years follow-up.
  
  
  METHODS
  Self-management with or without self-treatment of exacerbations was randomly assigned to patients. All patients participated in four self-management meetings. Patients in the self-treatment group (STG) also learned to use an action plan to start a course of prednisolone and/or antibiotics in case of worsening of symptoms. Primary outcome was the duration and severity of exacerbations.
  
  
  RESULTS
  Data of 70 COPD patients in the STG and 72 patients in the control group (CG) were analysed. Over 2 years, the median number of exacerbation days was significantly lower in the STG (50, IQR: 32-115) compared with the CG (82, IQR: 22-186) (P = 0.047), as was the mean symptom score of an exacerbation (STG: 43.4, IQR 27.2-68.6 vs CG: 55.9, IQR: 31.2-96.8) (P = 0.029). Also, patients in the STG visited the respiratory physician and emergency department less frequently than patients in the CG with incidence rate ratios of 1.52 (95% CI: 1.28-1.79) and 2.27 (95% CI: 1.11-4.62), respectively. Direct medical costs per patient over 2 years were €1078 lower in the STG.
  
  
  CONCLUSIONS
  Self-treatment of exacerbations is beneficial in COPD patients without significant comorbidities because it reduces exacerbation duration, exacerbation severity and health-care utilization leading to considerable cost savings.
authors.affiliation: Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Marlies
authors.initials: M
authors.lastname: Zwerink
authors.affiliation: Department of Pulmonology, University of Groningen, and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Huib Am
authors.initials: HA
authors.lastname: Kerstjens
authors.affiliation: Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.|Department of Research Methodology, Measurement and Data Analysis, University Twente, Enschede, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: van der Valk
authors.affiliation: Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Brusse-Keizer
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Zielhuis
authors.affiliation: Southern Adelaide Local Health Network, Respiratory Research Unit, Repatriation General Hospital, Daw Park, South Australia, Australia.|School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Tanja
authors.initials: T
authors.lastname: Effing
mesh_terms: D000328:Adult; D000368:Aged; D000075202:Contraindications; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000503:physiopathology / Q000628:therapy; D011788:Quality of Life; D012648:Self Care
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone
keywords: chronic obstructive pulmonary disease; cost-effectiveness; exacerbation; quality of life; self-management