Cost-benefit and cost-effectiveness analysis of self-management in patients with COPD--a 1-year follow-up randomized, controlled trial

Abstract

The aims were to explore the effects and health economic consequences of patient education in patients with COPD in a 12-month follow-up. Sixty-two patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) were at our outpatient clinic randomly allocated to an intervention group or a control group. The intervention group participated in a 4-h schooling, followed by one-to-two individual nurse and physiotherapist consultations. Self-management was emphasized following a stepwise treatment plan. Effectiveness was expressed in terms of proportions in need of general practitioner (GP) consultations, patient satisfaction and utilization of rescue medication. Doctor visits, days off work, dispensed pharmaceuticals, hospital admissions, travel costs, educational and time costs were recorded. The control and intervention groups induced mean total costs of NOK 19900 and 10600 per patient, respectively. The results were robustto realistic changes in the assumptions upon which they were based. For every NOK put into patient education, there was a saving of 4.8. The NNE to make one patient independent of their GP was 1.7 (95% CI: 1.3--2.8) and associated with a concomitant saving of NOK 15 800. The corresponding NNE to make one person satisfied with their GP was 4.5 (95% CI: 2.9--10) and NOK 41900, respectively. A reduced need of 100 DDD of rescue medication was associated with a concomitant saving of NOK5600. We conclude that patient education of patients with COPD in a 12-month follow-up improved patient outcomes and reduced costs.