Home-based pulmonary rehabilitation for COPD using minimal resources: An economic analysis

Angela T Burge; Anne E Holland; Christine F McDonald; Michael J Abramson; Catherine J Hill; Annemarie L Lee; Narelle S Cox; Rosemary Moore; Caroline Nicolson; Paul O'Halloran; Aroub Lahham; Rebecca Gillies; Ajay Mahal

doi:10.1111/resp.13667

Home-based pulmonary rehabilitation for COPD using minimal resources: An economic analysis

Respirology. 2020 Feb;25(2):183-190. doi: 10.1111/resp.13667. Epub 2019 Aug 16.

Authors

Angela T Burge^{1

2

3}, Anne E Holland^{1

2

3}, Christine F McDonald^{3

4

5}, Michael J Abramson⁶, Catherine J Hill^{2

3}, Annemarie L Lee^{1

2

3}, Narelle S Cox^{1

3}, Rosemary Moore³, Caroline Nicolson^{1

2}, Paul O'Halloran⁷, Aroub Lahham^{1

3}, Rebecca Gillies^{1

2}, Ajay Mahal⁸

Affiliations

¹ Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.
² Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.
³ Institute for Breathing and Sleep, Melbourne, VIC, Australia.
⁴ Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia.
⁵ Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.
⁶ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁷ Department of Public Health, La Trobe University, Melbourne, VIC, Australia.
⁸ The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia.

PMID: 31418515
DOI: 10.1111/resp.13667

Abstract

Background and objective: This study aimed to compare the cost-effectiveness and cost-utility of home and centre-based pulmonary rehabilitation for adults with stable chronic obstructive pulmonary disease (COPD).

Methods: Prospective economic analyses were undertaken from a health system perspective alongside a randomized controlled equivalence trial in which participants referred to pulmonary rehabilitation undertook a standard 8-week outpatient centre-based or a new home-based programme. Participants underwent clinical assessment prior to programme commencement, immediately following completion and 12 months following programme completion. They provided data for utility (quality-adjusted life years (QALY) determined using SF6D (utility scores for health states) calculated from 36-Item Short Form Health Survey version 2) and effectiveness (change in distance walked on 6-min walk test (Δ6MWD) following pulmonary rehabilitation ). Individual-level cost data for the 12 months following programme completion was sourced from healthcare administration and government databases.

Results: Between-group mean difference point estimates for cost (-$4497 (95% CI: -$12 250 to $3257), utility (0.025 (-0.038 to 0.086) QALY) and effectiveness (14 m (-11 to 39) Δ6MWD) favoured the home-based group. Cost-utility analyses demonstrated 63% of estimates falling in the dominant southeast quadrant and the probability that the new home-based model was cost-effective at a $0 threshold for willingness to pay was 78%. Results were robust to a range of sensitivity analyses. Programme completion was associated with significantly lower healthcare costs in the following 12 months.

Conclusion: Home-based pulmonary rehabilitation provides a cost-effective alternative model for people with COPD who cannot access traditional centre-based programmes.

Trial registration: ClinicalTrials.gov NCT01423227.

Keywords: chronic obstructive pulmonary disease; cost-benefit analysis; exercise therapy; healthcare costs; quality-adjusted life years.

Publication types

Comparative Study
Equivalence Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Ambulatory Care / economics*
Cost-Benefit Analysis
Exercise Therapy
Female
Health Care Costs*
Humans
Male
Middle Aged
Patient Compliance
Prospective Studies
Pulmonary Disease, Chronic Obstructive / physiopathology*
Pulmonary Disease, Chronic Obstructive / rehabilitation*
Quality of Life
Quality-Adjusted Life Years
Self Care / economics*
Self Care / methods
Treatment Outcome
Walk Test

Associated data

ClinicalTrials.gov/NCT01423227