scholarly journals Cost-effectiveness of telehealthcare to patients with chronic obstructive pulmonary disease: results from the Danish ‘TeleCare North’ cluster-randomised trial

BMJ Open ◽  
2017 ◽  
Vol 7 (5) ◽  
pp. e014616 ◽  
Author(s):  
Flemming Witt Udsen ◽  
Pernille Heyckendorff Lilholt ◽  
Ole Hejlesen ◽  
Lars Ehlers
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Pulmonary Disease ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Life Years ◽  
Quality Adjusted Life

ObjectivesTo investigate the cost-effectiveness of a telehealthcare solution in addition to usual care compared with usual care.DesignA 12-month cost-utility analysis conducted alongside a cluster-randomised trial.SettingCommunity-based setting in the geographical area of North Denmark Region in Denmark.Participants26 municipality districts define randomisation clusters with 13 districts in each arm. 1225 patients with chronic obstructive pulmonary disease were enrolled, of which 578 patients were randomised to telehealthcare and 647 to usual care.InterventionsIn addition to usual care, patients in the intervention group received a set of telehealthcare equipment and were monitored by a municipality-based healthcare team. Patients in the control group received usual care.Main outcome measureIncremental costs per quality-adjusted life-years gained from baseline up to 12 months follow-up.ResultsFrom a healthcare and social sector perspective, the adjusted mean difference in total costs between telehealthcare and usual care was €728 (95% CI −754 to 2211) and the adjusted mean difference in quality-adjusted life-years gained was 0.0132 (95% CI −0.0083 to 0.0346). The incremental cost-effectiveness ratio was €55 327 per quality-adjusted life-year gained. Decision-makers should be willing to pay more than €55 000 to achieve a probability of cost-effectiveness >50%. This conclusion is robust to changes in the definition of hospital contacts and reduced intervention costs. Only in the most optimistic scenario combining the effects of all sensitivity analyses, does the incremental cost-effectiveness ratio fall below the UK thresholds values (€21 068 per quality-adjusted life-year).ConclusionsTelehealthcare is unlikely to be a cost-effective addition to usual care, if it is offered to all patients with chronic obstructive pulmonary disease and if the willingness-to-pay threshold values from the National Institute for Health and Care Excellence are applied.Trial registrationClinicaltrials.gov, NCT01984840, 14 November 2013.

scholarly journals Cost-Effectiveness of Combination Therapy for Chronic Obstructive Pulmonary Disease

2008 ◽  
Vol 15 (8) ◽  
pp. 437-443 ◽  
Author(s):  
Anderson Chuck ◽  
Philip Jacobs ◽  
Irvin Mayers ◽  
Darcy Marciniuk
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Life Years

BACKGROUND: There is evidence that combination therapy (CT) in the form of long-acting beta2-agonists (LABAs) and inhaled corticosteroids can improve lung function for patients with chronic obstructive pulmonary disease (COPD).OBJECTIVE: To determine the cost-effectiveness of using CT in none, all or a selected group of COPD patients.METHODS: A Markov model was designed to compare four treatment strategies: no use of CT regardless of COPD severity (patients receive LABA only); use of CT in patients with stage 3 disease only (forced expiratory volume in 1 s [FEV1] less than 35% of predicted); use of CT in patients with stages 2 and 3 disease only (FEV1less than 50% of predicted); and use of CT in all patients regardless of severity of COPD. Estimates of mortality, exacerbation and disease progression rates, quality-adjusted life years (QALYs) and costs were derived from the literature. Three-year and lifetime time horizons were used. The analysis was conducted from a health systems perspective.RESULTS: CT was associated with a cost of $39,000 per QALY if given to patients with stage 3 disease, $47,500 per QALY if given to patients with stages 2 and 3 disease, and $450,333 per QALY if given to all COPD patients. Results were robust to various assumptions tested in a Monte Carlo simulation.CONCLUSION: Providing CT for COPD patients in stage 2 or 3 disease is cost-effective. The message to family physicians and specialists is that as FEV1worsens and reaches 50% of predicted values, CT is recommended.

PP09 Cost-Effectiveness Of Chronic Obstructive Pulmonary Disease Management

2019 ◽  
Vol 35 (S1) ◽  
pp. 38-39
Author(s):  
Thomas Plunkett ◽  
Paul Carty ◽  
Michelle O'Neill ◽  
Patricia Harrington ◽  
Susan M Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Pulmonary Disease ◽  
Cost Effective ◽  
Cochrane Library ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Cost

IntroductionTo inform the development of a national clinical guideline for Chronic Obstructive Pulmonary Disease (COPD), prioritized by the National Clinical Effectiveness Committee in Ireland, a systematic review was conducted to examine the cost-effectiveness of pulmonary rehabilitation programs (PRPs), outreach programs (OPs), and long-term oxygen therapy (LTOT), compared with usual care.MethodsMedline, Embase, the Cochrane Library and grey literature sources were searched up to 19 June 2018. Studies evaluating cost-effectiveness published post-2008 in English were included. Screening, data extraction, and quality assessment using the Consensus Health Economic Criteria and International Society for Pharmacoeconomics questionnaires were conducted independently by two reviewers. Costs were converted to 2017 Irish Euro using consumer price indices for health and purchasing power parity.ResultsFrom 8,661 articles identified, seven studies (one comparing both PRPs and LTOT) were included (PRPs: five; OPs: one; LTOT: two). PRP cost-utility analyses (n = 4) reported conflicting results due to considerable heterogeneity in program and study design, with incremental cost-effectiveness ratios (ICERs) ranging between EUR 12,391 and EUR 509,122 per quality adjusted life-year (QALY) gained. The remaining study investigated hospitalizations avoided and found outpatient and community-based PRPs to be dominant, while home-based PRP produced an ICER of EUR 1,913. OPs were found to be less costly, but also less effective. However, the results of the underpinning trial were neither statistically nor clinically significant. LTOT was found to be cost-effective, with ICERs of EUR 17,603 and EUR 26,936 per QALY gained.ConclusionsApplying a willingness-to-pay threshold of EUR 45,000 per QALY gained, this systematic review found that, compared with usual care, there is inconsistent but generally favorable evidence for PRPs, no clear evidence for the cost-effectiveness of OPs, and that LTOT is likely to be cost-effective. However, there was a lack of methodologically robust studies included in the review and most were not directly transferable to the Irish context.

Cost-effectiveness of a telemonitoring program (telEPOC program) in frequently admitted chronic obstructive pulmonary disease patients

2021 ◽  
pp. 1357633X2110372
Author(s):  
Cristóbal Esteban ◽  
Ane Antón ◽  
Javier Moraza ◽  
Milagros Iriberri ◽  
Mateo Larrauri ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cost Effectiveness ◽  
Pulmonary Disease ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Obstructive ◽  
Cost Effectiveness Ratio ◽  
Obstructive Pulmonary Disease ◽  
The Cost ◽  
Quality Adjusted Life

Chronic obstructive pulmonary disease is a typical disease among chronic and respiratory diseases. The costs associated with chronic disease care are rising dramatically, and this makes it necessary to redesign care processes, including new tools which allow the health system to be more sustainable without compromising on the quality of the care, compared to that currently provided. One approach may be to use information and communication technologies. In this context, we explored the cost-effectiveness of applying a telemonitoring system to a cohort of chronic obstructive pulmonary disease patients with frequent readmissions (the telEPOC programme). We conducted an intervention study with a control group. The inclusion criteria used were having chronic obstructive pulmonary disease (forced expiratory volume in the first second/forced vital capacity  < 70%) and having been hospitalised for exacerbation at least twice in the last year or three times in the last 2 years. We estimated the costs incurred by patients in each group and calculated the quality-adjusted life years and incremental cost-effectiveness ratio. Overall, 77 patients were included in the control group and 86 in the intervention group. The raw cost-effectiveness analysis showed that the cost of the telEPOC intervention was significantly lower than that of usual care, while there were no significant differences between the groups in effectiveness. The incremental cost-effectiveness ratio for the intervention was €175,719.71 per quality-adjusted life-year gained. There were no differences between the intervention group (telemonitoring) and the control group (standard care) from the cost-effectiveness point of view. On the other hand, the intervention programme (telEPOC) was less expensive than routine clinical practice.

scholarly journals Cost-effectiveness analysis of a single-inhaler triple therapy for COPD in the UK

2020 ◽  
pp. 00480-2020
Author(s):  
Elisabeth Fenwick ◽  
Alan Martin ◽  
Melanie Schroeder ◽  
Stuart J. Mealing ◽  
Oyinkansola Solanke ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
United Kingdom ◽  
Cost Effectiveness ◽  
Triple Therapy ◽  
Pulmonary Disease ◽  
Quality Adjusted Life Year ◽  
Chronic Obstructive ◽  
Fluticasone Furoate ◽  
Obstructive Pulmonary Disease ◽  
Quality Adjusted Life

IntroductionUnited Kingdom management costs for chronic obstructive pulmonary disease, estimated at £1.9 billion·year−1, are rising. In the FULFIL (Lung Function and Quality of Life Assessment in Chronic Obstructive Pulmonary Disease with Closed Triple Therapy) study, single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol (100/62.5/25 µg) improved clinical outcomes versus budesonide/formoterol (400/12 µg) in patients with symptomatic chronic obstructive pulmonary disease at risk of exacerbations. We assessed the cost-effectiveness of fluticasone furoate/umeclidinium/vilanterol versus budesonide/formoterol for treating chronic obstructive pulmonary disease from a United Kingdom National Health Service perspective.MethodsA model was developed combining a trial-based and Markov component and populated with baseline and treatment effect data from FULFIL, together with United Kingdom healthcare resource costs and disease-related utilities. Costs per life year and per quality-adjusted life year gained (costing year 2017) for fluticasone furoate/umeclidinium/vilanterol versus budesonide/formoterol were calculated for a lifetime horizon. Results were explored using deterministic sensitivity, scenario and probabilistic analyses.ResultsFluticasone furoate/umeclidinium/vilanterol was associated with gains in life years (0.533) and quality-adjusted life years (0.506) versus budesonide/formoterol, but at slightly increased total costs (£26 416 versus £25 860). This translated to incremental cost-effectiveness ratios of £1042/life year and £1098/quality-adjusted life year for fluticasone furoate/umeclidinium/vilanterol versus budesonide/formoterol. In scenario analyses, incremental cost-effectiveness ratios ranged from dominant to £1547/quality-adjusted life year gained.ConclusionsFluticasone furoate/umeclidinium/vilanterol provides a cost-effective treatment option versus budesonide/formoterol for patients with symptomatic chronic obstructive pulmonary disease in the United Kingdom.

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