Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management

Figures & data

Table 1.  Baseline characteristics

	COPE-active	Control
Number of patients	77	76
Age (years)	63.1 ± 8.1	64.1± 7.7
Gender (%male)	58.4%	57.9%
Body mass index (kg/m^2)	26.1 ± 5.0	26.8 ± 4.4
Smokers	35%	34%
Medical Research Council dyspnoea scale	2.25 ± 1.05	2.50 ± 1.15
FEV1 (L)	1.43 ± 0.54	1.40 ± 0.53
FEV1 (% of predicted)	49.6 ± 14.2	50.5 ± 17.0
VC (L)	3.78 ± 1.05	3.47 ± 0.84
Incremental shuttle walk test (m)^a	388 ± 165	341 ± 152
Daily physical activity (steps/day)^b	4472 ± 2716	5224 ± 3463
EQ-5D utility index score	0.74 ± 0.22	0.70 ± 0.24

Data are presented as mean ± standard deviation (sd) unless otherwise stated.

^a Mean values were based on 77 and 74 patients in the COPE-active and control group, respectively.

^b Mean values were based on 62 and 65 patients in the COPE-active and control group, respectively.

Figure 1.  Patient flow during 24 months follow-up.

Table 2.  Net changes in health outcomes and incremental cost effectiveness ratios of a self-management programme with vs. without a community-based exercise programme after 2 years of follow-up, 1 year of follow-up, and in the case of continuing exercise in the second year (hypothetical)

	COPE-active	Controls	Δ Net change	ICER
Cost-effectiveness after 2 years of follow-up (primary analysis), Δ direct medical costs € 438
Proportion of patients with:
≥ 47.5 m improvement on ISWT	0.16	0.1
≥ 47.5 m deterioration on ISWT	0.44	0.45
Net improvement	−0.28	−0.35	0.07 (−0.18; 0.33)	€ 6257
Proportion of patients with:
≥ 500 steps improvement	0.43	0.3
≥ 500 steps deterioration	0.34	0.49
Net improvement	0.09	−0.19	0.28 (−0.01; 0.59)	€ 1564
QALY's	1.53 (1.43; 1.63)	1.49 (1.39; 1.59)	0.04 (−0.10; 0.18)	€ 10 950
Cost-effectiveness after 1 year of follow-up, Δ direct medical costs € 983
Proportion of patients with:
≥ 47.5 m improvement on ISWT	0.29	0.15
≥ 47.5 m deterioration on ISWT	0.23	0.36
Net improvement	0.06	−0.21	0.27 (0.06; 0.48)	€ 3641
Proportion of patients with:
≥ 500 steps improvement	0.36	0.27
≥ 500 steps deterioration	0.31	0.44
Net improvement	0.05	−0.17	0.22 (−0.06; 0.49)	€ 4468
QALY's	0.76 (0.71; 0.81)	0.75 (0.70; 0.80)	0.01 (−0.06; 0.08)	€98 300
Cost-effectiveness after 2 years of follow-up with continuation of exercise in the second year (hypothetical), Δ direct medical costs € 946
Proportion of patients with:
≥ 47.5 m improvement on ISWT	0.29	0.15
≥ 47.5 m deterioration on ISWT	0.23	0.36
Net improvement	0.06	−0.21	0.27 (0.06; 0.48)	€ 3504
Proportion of patients with:
≥ 500 steps improvement	0.43	0.3
≥ 500 steps deterioration	0.34	0.49
Net improvement	0.09	−0.19	0.28 (−0.01; 0.59)	€ 3379
QALY's	1.53 (1.43; 1.63)	1.49 (1.39; 1.59)	0.04 (−0.10; 0.18)	€23 650

Difference in (Δ) net changes and QALYs are presented as mean (difference) with 95% confidence interval. ISWT: incremental shuttle walk test; QALY: quality-adjusted life year presented as mean (95% confidence interval); ICER: incremental cost-effectiveness ratio.

Figure 2.  Decision analytic model of a self-management programme including a community-based exercise programme (COPE-active) vs. self-management only (control).

Table 3.  Mean costs (€) per patient over 2 years in patients participating in a self-management programme with and without community-based exercise

	COPE-active	Controls	Δ COPE-active – Controls
Self-management course	123	123	0
Physiotherapy	1648	469	1179
Health care contacts^1	692	704	−12
Patients with an exacerbation	724 (93%)	740 (92%)
Patients without an exacerbation	329 (7%)	292 (8%)
Hospital admission	3051	3863	−812
General respiratory medication	1355	1275	80
Medication for exacerbation^2	79	75	3
Total costs	6949	6511	438

¹ Includes pulmonary physician (telephone) and general practitioner consultations, and ED visits.

² Excluding costs during hospitalisation.

Figure 3.  (a) Cost-effectiveness plane of the difference in costs against the difference in net deterioration of distance walked on the incremental shuttle walk test (ISWT, m). A positive difference in net deterioration in steps/day and a negative difference in costs are in favour of the COPE-active group. (b) Cost-effectiveness plane of the difference in costs against the difference in net improvement of physical activity (steps/day). A positive difference in net improvement of steps/day and a negative difference in costs are in favour of the COPE-active group. (c) Cost-effectiveness plane of the difference in costs against the difference in QALYs. A positive difference in QALYs and a negative difference in costs are in favour of the COPE-active group.