Simulation-Based Estimates of the Effectiveness and Cost-Effectiveness of Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease in France.
BACKGROUND
The medico-economic impact of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is poorly documented.


OBJECTIVE
To estimate the effectiveness and cost-effectiveness of pulmonary rehabilitation in a hypothetical cohort of COPD patients.


METHODS
We used a multi-state Markov model, adopting society's perspective. Simulated cohorts of French GOLD stage 2 to 4 COPD patients with and without pulmonary rehabilitation were compared in terms of life expectancy, quality-adjusted life years (QALY), disease-related costs, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses included variations of key model parameters.


RESULTS
At the horizon of a COPD patient's remaining lifetime, pulmonary rehabilitation would result in mean gain of 0.8 QALY, with an over disease-related costs of 14 102 € per patient. The ICER was 17 583 €/QALY. Sensitivity analysis showed that pulmonary rehabilitation was cost-effective in every scenario (ICER <50 000 €/QALY).


CONCLUSIONS
These results should provide a useful basis for COPD pulmonary rehabilitation programs.
INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Sorbonne Universités.
Kokuvi
K
Atsou
INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Sorbonne Universités.|UPMC Univ Paris 06, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France.
Perrine
P
Crequit
GRC OncoTho, Paris Est, UPEC, Créteil, CHI Créteil, Service de Pneumologie, Créteil, France.
Christos
C
Chouaid
INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Sorbonne Universités.|UPMC Univ Paris 06, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France.
Gilles
G
Hejblum
D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000191:economics*; D003663:Decision Trees; D005602:France; D006801:Humans; D011336:Probability; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000534:rehabilitation*; D012119:Respiration; D012680:Sensitivity and Specificity; D016896:Treatment Outcome