Cost-effectiveness of the COPD Patient Management European Trial home-based disease management program

• Published in: International journal of chronic obstructive pulmonary disease Vol. 14; pp. 645 - 657
• Main Authors: Bourbeau, Jean, Granados, Denis, Roze, Stéphane, Durand-Zaleski, Isabelle, Casan, Pere, Köhler, Dieter, Tognella, Silvia, Viejo, Jose Luis, Dal Negro, Roberto W, Kessler, Romain
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2019; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Budgets; Chronic obstructive lung disease; Clinical outcomes; COPD; Cost analysis; Cost control; Cost estimates; Cost Savings; Cost-Benefit Analysis; Cost-effectiveness; Disease management; Diseases; Economic aspects; Europe; France; Germany; Health aspects; Health care; Health Care Costs; Health services; Health Status; Healthcare Disparities - economics; Home Care Services - economics; Home-based disease management; Hospitals; Human health and pathology; Humans; Intervention; Life expectancy; Life Sciences; Medical economics; Mortality; Original Research; Patients; Programming languages; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - economics; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - therapy; Quality of Life; Quality-Adjusted Life Years; Socialized medicine; Software; Spain; Strategic planning (Business); Time Factors; Treatment Outcome; United Kingdom; Europe; United Kingdom; France; Germany; Spain; home-based disease management; cost-effectiveness; France; Germany; COPD; Spain
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S173057

Efficient management of COPD represents an international challenge. Effective management strategies within the means of limited health care budgets are urgently required. This analysis aimed to evaluate the cost-effectiveness of a home-based disease management (DM) intervention vs usual management (UM) in patients from the COPD Patient Management European Trial (COMET).
Cost-effectiveness was evaluated in 319 intention-to-treat patients over 12 months in COMET. The analysis captured unplanned all-cause hospitalization days, mortality, and quality-adjusted life expectancy. Costs were evaluated from a National Health Service perspective for France, Germany, and Spain, and in a pooled analysis, and were expressed in 2015 Euros (EUR). Quality of life was assessed using the 15D health-related quality-of-life instrument and mapped to utility scores.
Home-based DM was associated with improved mortality and quality-adjusted life expectancy. DM and UM were associated with equivalent direct costs (DM reduced costs by EUR -37 per patient per year) in the pooled analysis. DM was associated with lower costs in France (EUR -806 per patient per year) and Spain (EUR -51 per patient per year), but higher costs in Germany (EUR 391 per patient per year). Evaluation of cost per death avoided and cost per quality-adjusted life year (QALY) gained showed that DM was dominant (more QALYs and cost saving) in France and Spain, and cost-effective in Germany vs UM. Nonparametric bootstrapping analysis, assuming a willingness-to-pay threshold of EUR 20,000 per QALY gained, indicated that the probability of home-based DM being cost-effective vs UM was 87.7% in France, 81.5% in Spain, and 75.9% in Germany.
Home-based DM improved clinical outcomes at equivalent cost vs UM in France and Spain, and in the pooled analysis. DM was cost-effective in Germany with an incremental cost-effectiveness ratio of EUR 2,541 per QALY gained. The COMET home-based DM intervention could represent an attractive alternative to UM for European health care payers.