Self-management support for moderate-to-severe chronic obstructive pulmonary disease: a pilot randomised controlled trial

Abstract

Background: Better self management could improve quality of life (QoL) and reduce hospital admissions in chronic obstructive pulmonary disease (COPD), but the best way to promote it remains unclear.

Aim: To explore the feasibility, effectiveness and cost effectiveness of a novel, layperson-led, theoretically driven COPD self-management support programme.

Design and setting: Pilot randomised controlled trial in one UK primary care trust area.

Method: Patients with moderate to severe COPD were identified through primary care and randomised 2:1 to the 7-week-long, group intervention or usual care. Outcomes at baseline, 2, and 6 months included self-reported health, St George's Respiratory Questionnaire (SGRQ), EuroQol, and exercise.

Results: Forty-four per cent responded to GP invitation, 116 were randomised: mean (standard deviation [SD]) age 69.5 (9.8) years, 46% male, 78% had unscheduled COPD care in the previous year. Forty per cent of intervention patients completed the course; 35% attended no sessions; and 78% participants completed the 6-month follow-up questionnaire. Results suggest that the intervention may increase both QoL (mean EQ-5D change 0.12 (95% confidence interval [CI] = -0.02 to 0.26) higher, intervention versus control) and exercise levels, but not SGRQ score. Economic analyses suggested that with thresholds of £20 000 per quality-adjusted life-year gained, the intervention is likely to be cost-effective.

Conclusion: This intervention has good potential to meet the UK National Institute for Health and Clinical Excellence criteria for cost effectiveness, and further research is warranted. However, to make a substantial impact on COPD self-management, it will also be necessary to explore other ways to enable patients to access self-management education.

Figure 1

Flow chart for the study.

Figure 2

Incremental cost-effectiveness ratios (ICERs) predicted from a bootstrap calculation with 1000 replications, showing the relationship between the mean difference in costs and mean difference in benefits for the BELLA intervention.

Figure 3

Cost-effectiveness acceptability curve (CEAC) for the BELLA intervention showing the probability that the intervention is cost effective across different willingness-to-pay thresholds.