Cost-effectiveness of physical activity in the management of COPD patients in the UK

Abstract

Background

While the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines advise exercise to reduce disease progression, little investment in promoting physical activity (PA) is made by health care authorities. The purpose of this study was to estimate the cost-effectiveness of regular PA vs sedentary lifestyle in people with COPD in the UK.

Methods

Efficacy, quality of life, and economic evidence on the PA effects in COPD patients were retrieved from literature to serve as input for a Markov microsimulation model comparing a COPD population performing PA vs a COPD population with sedentary lifestyle. The GOLD classification defined the model health states. For the base case, the cost of PA was estimated at zero, a lifetime horizon was used, and costs and effects were discounted at 3.5%. Analyses were performed from the UK National Health Service (NHS) perspective. Uncertainty around inputs and assumptions were explored via scenario and sensitivity analyses, including a cost threshold analysis. Outcomes were cost/quality-adjusted life year (QALY) gained and cost/year gained.

Results

Based on our model, the effects of PA in the UK COPD population would be lower mortality (−6%), fewer hospitalizations (−2%), gains in years (+0.82) and QALYs (+0.66), and total cost savings of £2,568. The cost/QALY and cost/year gained were dominant. PA was cost-saving at costs <£35/month and cost-effective at cost <£202/month. The main model drivers were age and PA impact on death and hospital-treated exacerbations.

Conclusion

Including PA in the management of COPD leads to long-term clinical benefits. If the NHS promotes only exercise via medical advice, this would lead to health care cost savings. If the NHS chose to fund PA, it would still likely be cost-effective.

Keywords:

• cost-effectiveness
• physical activity
• exercise
• COPD
• microsimulation
• Markov

Acknowledgments

This submission represents the original work not being considered by any other journal. This study was sponsored by AstraZeneca SA.

Author contributions

MR, LG, ML, PS, and JH made substantial contributions to the conception and design of the study, or acquisition of data, or analysis and interpretation of data. All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

JH received consulting fees for providing information on the management of COPD in the UK. MR, ML, and LG are employees of IQVIA and received consulting fees for developing the model and/or writing the manuscript. PS and AMC are employees of AstraZeneca. The authors report no other conflicts of interest in this work.