Economic Evaluation of a Disease Management Program for Chronic Obstructive Pulmonary Disease

Figures & data

Table 1.  Hospitalizations and emergency department visits during follow-up

	Disease Management (n = 372)	Usual care (N = 371)	Rate ratio (95% CI)	P-value
COPD
Hospitalization or ED visit	48.4	82.2	0.59 (0.44, 0.78)	< 0.001
Hospitalization	27.6	39.8	0.69 (0.47, 1.01)	0.08
ED visit	20.8	42.4	0.49 (0.33, 0.72)	< 0.001
Cardiac or non-COPD pulmonary
Hospitalization or ED visit	18.3	26.8	0.68 (0.44, 1.05)	0.06
Hospitalization	8.7	17.0	0.51 (0.29, 0.90)	0.01
ED visit	9.6	9.8	0.98 (0.56, 1.70)	0.93
Other than pulmonary or cardiac
Hospitalization or ED visit	56.6	60.9	0.93 (0.69, 1.25)	0.58
Hospitalization	20.6	21.9	0.94 (0.61, 1.31)	0.72
ED visit	36.0	39.0	0.92 (0.65, 1.31)	0.64
All cause
Hospitalization or ED visit	123.8	170.5	0.73 (0.58, 0.90)	< 0.003
Hospitalization	56.8	79.3	0.72 (0.54, 0.94)	0.02
ED visit	67.0	91.2	0.73 (0.56, 0.96)	0.02

ED, emergency department.

Results expressed as mean events per 100 patient-years.

Table 2a.  Disease management program related costs using respiratory therapists

Resource	Unit Cost	Units for the 5 participating VA centers	Total Cost
Printed educational material	$1 per booklet	400	$400
Telephone and line	$420 per year	5	$2100
Respiratory therapist salary and fringe benefits	$59,780 per FTE	4	$239,120
Total			$241,620
Per patient cost			$650

Table 2b.  Disease management program costs using registered nurses

Printed educational material	$1 per booklet	400	$400
Telephone and line	$420 per year	5	$2100
Registered nurses salary and fringe benefits	$78,304 per FTE	4	$313,216
Total			$315,716
Per patient cost			$849

FTE = full time equivalent.

Table 3.  Mean per patient direct health care costs (U.S. Dollars) in the two treatment groups^*

	Disease Management (n = 372)		Usual Care (n = 371)
Cost Variables	Number	Cost ($)	Number	Cost ($)	Difference per Patient ($)
Hospitalizations	202	3493 ± 4260	275	4610 ± 4599	−1117
Emergency Department visits	238	221 ± 557	316	362 ± 729	−141
Pulmonary Drug Prescriptions	372	127 ± 139	371	112 ± 157	+15
Total		3841 ± 4678		5084 ± 5060	−1243

^*Mean ± SD.

Table 4.  Impact of respiratory therapist case load on cost in the two treatment groups

Patient caseload per respiratory therapist (No.)	Disease Management Group (n = 372) Cost per patient ($)	Usual Care Group (n = 371) Cost per patient ($)	P-value
93
Healthcare Cost	3841 ± 4678	5084 ± 5060
Disease Management Cost	650	0
Total Cost	4491 ± 4678	5084 ± 5060
Mean Difference	−593 (95% CI, −1856 to 678)		p = 0.52
125
Healthcare Cost	3841 ± 4678	5084 ± 5060
Disease Management Cost	484	0
Total Cost	4325 ± 4678	5084 ± 5060
Mean Difference	−759 (95% CI, −2022 to 512)		p = 0.44
150
Healthcare Cost	3841 ± 4678	5084 ± 5060
Disease Management Cost	403	0
Total Cost	4244 ± 4678	5084 ± 5060
Mean Difference	−840 (95% CI, −2189 to 409)		p = 0.39

Table 5.  Sensitivity analysis of a nurse case management program on cost in the two treatment groups

Patient caseload per respiratory therapist (No.)	Disease Management Group (n = 372) Cost per patient ($)	Usual Care Group (n = 371) Cost per patient ($)	P-value
93
Healthcare Cost	3841 ± 4678	5084 ± 5060
Disease Management Cost	849	0
Total Cost	4690 ± 4678	5084 ± 5060
Mean Difference	−394 (95% CI – 1668 to 889)		0.61
125
Healthcare Cost	3841 ± 4678	5084 ± 5060
Disease Management Cost	632	0
Total Cost	4473 ± 4678	5084 ± 5060
Mean Difference	−611 (95% CI – 1905 to 695)		0.52
150
Healthcare Cost	3841 ± 4678	5084 ± 5060
Disease Management Cost	526	0
Total Cost	4367 ± 4678	5084 ± 5060
Mean Difference	−717 (95%CI – 2071 to 625)		0.46