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Cost analysis of an integrated care model in the management of acute exacerbations of chronic obstructive pulmonary disease

Research SpR and Lecturer, Respiratory Medicine, Walsgrave Hospital, Coventry, UK, nawar.bakerly{at}srft.nhs.uk

C. Davies

Institute of Medical Education, Warwick Medical School, University of Warwick, Coventry, UK

M. Dyer

Health Economics Research Group, National Collaborating Centre for Mental Health, London, UK

P. Dhillon

University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK

Home treatment models for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) proved to be a safe alternative to hospitalization. These models have the potential to free up resources; however, in the United Kingdom, it remains unclear to whether they provide cost savings compared with hospital treatment. Over a 12-month period from August 2003, 130 patients were selected for the integrated care group (total admissions with AECOPD = 546). These patients were compared with 95 retrospective controls in the hospital treatment group. Controls were selected from admissions during the previous 12 months (total of 662 admissions) to match the integrated care group in age, sex, and postal code. Resource use data were collected for both groups and compared using National Health Service (NHS) perspective for cost minimization analysis. In the integrated care group (130 patients), 107 (82%) patients received home support with average length of stay 3.3 (SD 3.9) days compared with 10.4 (SD 7.7) in the hospital group (95 patients). Average number of visits per patients in the integrated care group was 3.08 (SD = 0.95; 95% CI = 2.9—3.2). Cost per patient in the integrated care group was £1653 (95% CI, £1521—1802) compared with £2256 (95% CI, £2126— 2407) in the hospital group. The integrated care group resulted in cost saving of approximately £600 (P < 0.001) per patient. This integrated care model for the management of patients with AECOPD offered cost savings of £600 per patient over the conventional hospital treatment model using the new NHS tariff from an acute trust provider perspective.

Key Words: COPD • cost • early discharge • exacerbation • integrated care

This version was published on November 1, 2009

Chronic Respiratory Disease, Vol. 6, No. 4, 201-208 (2009)
DOI: 10.1177/1479972309104279


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