Cost-effectiveness of the COPD Patient Management European Trial home-based disease management program.
Int J Chron Obstruct Pulmon Dis
; 14: 645-657, 2019.
Article
em En
| MEDLINE
| ID: mdl-30936689
ABSTRACT
Purpose:
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).Methods:
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.Results:
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.Conclusion:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Custos de Cuidados de Saúde
/
Doença Pulmonar Obstrutiva Crônica
/
Disparidades em Assistência à Saúde
/
Serviços de Assistência Domiciliar
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Evaluation_studies
/
Health_economic_evaluation
Aspecto:
Determinantes_sociais_saude
/
Patient_preference
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Revista:
Int J Chron Obstruct Pulmon Dis
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Canadá