CONTEXT: There is emerging evidence that disease management with self-management education provided by a case manager might benefit COPD patients. OBJECTIVE: To determine whether disease management with self-management education is more cost-effective than usual care among previously hospitalized COPD patients. DESIGN: Economic analysis in conjunction with a multicenter randomized clinical trial comparing patients conducting self-management with those receiving usual care over a 1-year follow-up period. SETTING:Respiratory referral centers. PATIENTS: One hundred ninety-one COPD patients who required hospitalization in the year preceding enrollment were recruited from seven respiratory outpatient clinics. INTERVENTION: In addition to usual care, patients in the intervention group received standardized education on COPD self-management program called "Living Well with COPD" with ongoing supervision by a case manager. MAIN OUTCOME MEASURES: From the perspective of the health-care payer, we compared costs between the two groups and estimated the program cost per hospitalization prevented (incremental cost-effectiveness ratio of the program). We repeated these estimates for several alternate scenarios of patient caseload. RESULTS: The additional cost of the self-management program as compared to usual care, $3,778 (2004 Canadian dollars) per patient, exceeded the savings of $3,338 per patient based on the study design with a caseload of 14 patients per case manager. However, through a highly plausible sensitivity analysis, it was showed that if case managers followed up 50 patients per year, the self-management intervention would be cost saving relative to usual care (cost saving of $2,149 per patient; 95% confidence interval, $38 to $4,258). With more realistic potential caseloads of 50 to 70 patients per case manager, estimated program costs would be $1,326 and $1,016 per prevented hospitalization, respectively. CONCLUSION: The program of self-management in COPD holds promise for positive economic benefits with increased patient caseload and rising costs of hospitalization.
RCT Entities:
CONTEXT: There is emerging evidence that disease management with self-management education provided by a case manager might benefit COPDpatients. OBJECTIVE: To determine whether disease management with self-management education is more cost-effective than usual care among previously hospitalized COPDpatients. DESIGN: Economic analysis in conjunction with a multicenter randomized clinical trial comparing patients conducting self-management with those receiving usual care over a 1-year follow-up period. SETTING: Respiratory referral centers. PATIENTS: One hundred ninety-one COPDpatients who required hospitalization in the year preceding enrollment were recruited from seven respiratory outpatient clinics. INTERVENTION: In addition to usual care, patients in the intervention group received standardized education on COPD self-management program called "Living Well with COPD" with ongoing supervision by a case manager. MAIN OUTCOME MEASURES: From the perspective of the health-care payer, we compared costs between the two groups and estimated the program cost per hospitalization prevented (incremental cost-effectiveness ratio of the program). We repeated these estimates for several alternate scenarios of patient caseload. RESULTS: The additional cost of the self-management program as compared to usual care, $3,778 (2004 Canadian dollars) per patient, exceeded the savings of $3,338 per patient based on the study design with a caseload of 14 patients per case manager. However, through a highly plausible sensitivity analysis, it was showed that if case managers followed up 50 patients per year, the self-management intervention would be cost saving relative to usual care (cost saving of $2,149 per patient; 95% confidence interval, $38 to $4,258). With more realistic potential caseloads of 50 to 70 patients per case manager, estimated program costs would be $1,326 and $1,016 per prevented hospitalization, respectively. CONCLUSION: The program of self-management in COPD holds promise for positive economic benefits with increased patient caseload and rising costs of hospitalization.
Authors: Anke Lenferink; Marjolein Brusse-Keizer; Paul Dlpm van der Valk; Peter A Frith; Marlies Zwerink; Evelyn M Monninkhof; Job van der Palen; Tanja W Effing Journal: Cochrane Database Syst Rev Date: 2017-08-04
Authors: Jan van Lieshout; Margalith Goldfracht; Stephen Campbell; Sabine Ludt; Michel Wensing Journal: Br J Gen Pract Date: 2011-01 Impact factor: 5.386
Authors: Maher R Khdour; Ashley M Agus; Joseph C Kidney; Bronagh M Smyth; James C McElnay; James C Elnay; Grainne E Crealey Journal: Int J Clin Pharm Date: 2011-06-04
Authors: Esther Dajczman; Chantal Robitaille; Pierre Ernst; Andrew Michael Hirsch; Norman Wolkove; David Small; Judy Bianco; Hartley Stern; Mark Palayew Journal: Can Respir J Date: 2013 Sep-Oct Impact factor: 2.409
Authors: Denis E O'Donnell; Shaw Aaron; Jean Bourbeau; Paul Hernandez; Darcy D Marciniuk; Meyer Balter; Gordon Ford; Andre Gervais; Rogers Goldstein; Rick Hodder; Alan Kaplan; Sean Keenan; Yves Lacasse; Francois Maltais; Jeremy Road; Graeme Rocker; Don Sin; Tasmin Sinuff; Nha Voduc Journal: Can Respir J Date: 2007-09 Impact factor: 2.409