Cost-Effectiveness of Early Assisted Discharge for COPD Exacerbations in The Netherlands

Goossens, Lucas; Utens, Cecile M.A.; Smeenk, Frank W.J.M.; Schayck, Onno C. P. van; Vliet, Monique van; Litsenburg, Walter van; Braken, Maria W; Mölken, Maureen P.M.H. Rutten-van

doi:10.1016/j.jval.2013.01.010

Cited by 25 publications

(38 citation statements)

References 25 publications

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“…Although not pre-specified by the Task Force as outcomes of interest, it is worth noting that four trials reported costs, and three reported patient and provider satisfaction. Among the trials that evaluated costs, two found lower costs for hospital-at-home programmes [67,70], one found a trend toward lower costs [66] and one found no difference [73]. Among the three trials that evaluated patient and provider satisfaction, all reported no differences [69,70,74].…”

Section: Other Considerationsmentioning

confidence: 99%

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

et al. 2017

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This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available.

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Section: Other Considerationsmentioning

confidence: 99%

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

et al. 2017

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“…The cost-effectiveness study based in the Netherlands showed no real difference in healthcare costs between arms, though the mean difference was marginally lower for domiciliary care by 168 euros at 3 months of follow-up. 26 The second economic evaluation was based in the United Kingdom and showed a large mean difference in health and social costs at 90 days of 1068 euros favouring HAH, which showed non-inferiority but not superiority, with a 90% chance of cost-effectiveness. 25 Part of the reason for the differences in these economic evaluations may be due to inherent differences between these healthcare systems and to the selected model of care.…”

Section: Benefit Of Domiciliary Care Programmesmentioning

confidence: 99%

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

Bourbeau

Echevarria

2020

Chron Respir Dis

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Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality, and treatments require a multidisciplinary approach to address patient needs. This review considers different models of care across the continuum of exacerbations (1) chronic care and self-management interventions with the action plan, (2) domiciliary care for severe exacerbation and the impact on readmission prevention and (3) the discharge care bundle for management beyond the acute exacerbation episode. Self-management strategies include written action plans and coaching with patient and family support. Self-management interventions facilitate the delivery of good care, can reduce exacerbations associated with admission, be cost-effective and improve quality of life. Hospitalization as a complication of exacerbation is not always unavoidable. Domiciliary care has been proposed as a solution to replace part, and perhaps even all, of the patient’s in-hospital stay, and to reduce hospital bed days, readmission rates and costs; low-risk patients can be identified using risk stratification tools. A COPD discharge bundle is another potentially important approach that can be considered to improve the management of COPD exacerbations complicated by hospital admission; it comprised treatments that have demonstrated efficacy, such as smoking cessation, personalized pharmacotherapy and non-pharmacotherapy such as pulmonary rehabilitation. COPD bundles may also improve the transition of care from the hospital to the community following exacerbation and may reduce readmission rates. Future models of care should be personalized – providing patient education aiming at behaviour changes, identifying and treating co-morbidities, and including outcomes that measure quality of care rather than focusing only on readmission quantity within 30 days.

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“…The GO AHEAD trial, which compared early assisted discharge with a conventional hospital admission did not lead to the conclusion that either treatment was clearly preferable from a medical or economic point of view [13,14]. No clear and significant differences were found in health outcomes or costs, although early assisted discharge was more likely to be the less costly alternative from the health care perspective.…”

Section: Introductionmentioning

confidence: 99%

Should I Stay or Should I Go Home? A Latent Class Analysis of a Discrete Choice Experiment on Hospital-At-Home

et al. 2014

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Cost-Effectiveness of Early Assisted Discharge for COPD Exacerbations in The Netherlands

Abstract: No clear evidence was found to conclude that either treatment was more effective or less costly.

Cited by 25 publications

References 25 publications

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

Should I Stay or Should I Go Home? A Latent Class Analysis of a Discrete Choice Experiment on Hospital-At-Home

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