Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme

• Published in: Thorax 2001-10, Vol.56 (10), p.779-784
• Main Authors: Griffiths, T L, Phillips, C J, Davies, S, Burr, M L, Campbell, I A
• Format: Article
• Language: English
• Subjects: Ambulatory medical care; Analysis; Biological and medical sciences; Care and treatment; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Cost-Benefit Analysis; Costs; Disability; Health Care Costs; Health services; Humans; Intervention; Lung diseases; Lung Diseases, Obstructive - drug therapy; Lung Diseases, Obstructive - rehabilitation; Medical care, Cost of; Medical sciences; Models, Economic; Occupational therapy; Original; Outpatient Clinics, Hospital - economics; Outpatient Clinics, Hospital - statistics & numerical data; Patients; Physical therapy; Pneumology; Quality of life; Quality-Adjusted Life Years; Rehabilitation; Travel; Utilization
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax.56.10.779

BACKGROUND Pulmonary rehabilitation programmes improve the health of patients disabled by lung disease but their cost effectiveness is unproved. We undertook a cost/utility analysis in conjunction with a randomised controlled clinical trial of pulmonary rehabilitation versus standard care. METHODS Two hundred patients, mainly with chronic obstructive pulmonary disease, were randomly assigned to either an 18 visit, 6 week rehabilitation programme or standard medical management. The difference between the mean cost of 12 months of care for patients in the rehabilitation and control groups (incremental cost) and the difference between the two groups in quality adjusted life years (QALYs) gained (incremental utility) were determined. The ratio between incremental cost and utility (incremental cost/utility ratio) was calculated. RESULTS Each rehabilitation programme for up to 20 patients cost £12 120. The mean incremental cost of adding rehabilitation to standard care was £ –152 (95% CI –881 to 577) per patient, p=NS. The incremental utility of adding rehabilitation was 0.030 (95% CI 0.002 to 0.058) QALYs per patient, p=0.03. The point estimate of the incremental cost/utility ratio was therefore negative. The bootstrapping technique was used to model the distribution of cost/utility estimates possible from the data. A high likelihood of generating QALYs at negative or relatively low cost was indicated. The probability of the cost per QALY generated being below £0 was 0.64. CONCLUSIONS This outpatient pulmonary rehabilitation programme produces cost per QALY ratios within bounds considered to be cost effective and is likely to result in financial benefits to the health service.