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Economic evaluation of a comprehensive self-management programme in patients with moderate to severe chronic obstructive pulmonary disease

P Van der valk

Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands

T Schermer

Department of General Practice/Family Medicine, University Medical Centre, Nijmegen, The Netherlands

J Van der palen

Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands

C Van herwaarden

Department of Pulmonary Medicine, University Medical Centre, Nijmegen, The Netherlands

G Zielhuis

Department of Epidemiology and Biostatistics, University Medical Centre, Nijmegen, The Netherlands

Aims: The main objective of this study was to investigate whether a comprehensive self-management programme, including self-treatment guidelines for exacerbations and a fitness programme, is an efficient treatment option for chronic obstructive pulmonary disease (COPD) patients. Method: We randomly allocated 248 COPD patients to either self-management (127) or usual care (121). Data on preference-based utilities (EuroQol-5D), health-related quality of life (HRQoL), health-care resource use and productivity losses associated with exacerbations were prospectively collected. Quality-adjusted life years (QALYs) were calculated. The economic analysis took the societal perspective and the observation period was one year. Results: As we observed that the groups were equally effective in terms of QALYs and HRQoL (SGRQ), we described a cost minimization analysis only. The self-management programme-specific costs amounted to 6642 per patient. In the base-case cost analysis, the incremental cost difference amounted to 838 per patient per year in favour of usual care. When only direct medical costs were included, the incremental annual cost of self-managementrelative to usual care was 179 per person per year. If time costs for the fitness programme were set to zero, the costs for self-management diminished to 542. Sensitivity analysis showed that these results were robust to changes in the underlying assumptions. Conclusion: We conclude that the COPE self-management programme is not an efficient treatment option for moderate to severe COPD patients who rate their HRQoL relatively high. The programme was twice as expensive as usual care and had no measurable beneficial effects on QALYs or HRQoL.

Key Words: chronic obstructive lung disease • economics • patient education • randomized controlled trial

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