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Clinical Trial
. 2019 Mar 14:14:645-657.
doi: 10.2147/COPD.S173057. eCollection 2019.

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

Jean Bourbeau  1 , Denis Granados  2 , Stéphane Roze  3 , Isabelle Durand-Zaleski  4 , Pere Casan  5 , Dieter Köhler  6 , Silvia Tognella  7 , Jose Luis Viejo  8 , Roberto W Dal Negro  9 , Romain Kessler  10
Affiliations
Clinical Trial

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

Jean Bourbeau et al. Int J Chron Obstruct Pulmon Dis. .

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.

Keywords: COPD; France; Germany; Spain; cost-effectiveness; home-based disease management.

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Conflict of interest statement

Disclosure JB, IDZ, PC, DK, ST, JLV, RWDN, and RK were investigators in the COMET trial and have received honoraria from Air Liquide Healthcare, sponsors of the COMET trial. DG was an employee of Air Liquide Healthcare at the time when the study was conducted. SR is a director of HEVA HEOR, which received consulting fees from Air Liquide Healthcare to perform the health economic analysis described here. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Cost-utility scatter plots for DM vs UM. Notes: Scatter plots show the results of nonparametric bootstrapping with each black circle representing incremental costs (EUR) and incremental effectiveness (QALYs) for DM vs UM. Deterministic outcomes are represented by a red circle. Abbreviations: DM, disease management; EUR, Euros; QALY, quality-adjusted life year; UM, usual management.
Figure 2
Figure 2
Cost-utility acceptability curves for DM vs UM. Note: Willingness-to-pay threshold is expressed as cost per QALY gained for DM vs UM. Abbreviations: DM, disease management; QALY, quality-adjusted life year; UM, usual management.
Figure 3
Figure 3
Cost per death avoided scatter plots for DM vs UM. Notes: Scatter plots show the results of nonparametric bootstrapping with each black circle representing incremental costs (EUR) and number of deaths avoided for DM vs UM. Deterministic outcomes are represented by a red circle. Abbreviations: DM, disease management; EUR, Euros; UM, usual management.
Figure 4
Figure 4
Cost per death avoided acceptability curves for DM vs UM. Note: Willingness-to-pay threshold is expressed as cost per death avoided for DM vs UM. Abbreviations: DM, disease management; UM, usual management.
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