Identifying potentially cost effective chronic care programs for people with COPD

Abstract

Objective

To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified.

Methods

Systematic search of Medline and Cochrane databases for evaluations of multi-component disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized.

Results

Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money.

Conclusion

Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of ‘perfect data’, support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision uncertainty.

Keywords:

• chronic care management
• COPD
• cost-effectiveness
• review

Acknowledgment

This review study was supported by an unrestricted grant from PICASSO for COPD, an initiative of Pfizer B.V. and Boehringer Ingelheim B.V. in cooperation with research institute CAPHRI (School for Care and Public Health Research) of Maastricht University Medical Centre.

Disclosure

The authors report no conflicts of interest in this work.

Notes

1,* For reasons of simplicity, future benefits and costs are not discounted in this illustration.

2,* For reasons of simplicity, future benefits and costs are not discounted in this illustration.