Economic Evaluation of a Community-Based Pulmonary Rehabilitation Program for Chronic Obstructive Pulmonary Disease

Abstract

Pulmonary rehabilitation has been demonstrated to be efficacious in chronic obstructive pulmonary disease (COPD), however, its cost-effectiveness is largely unknown. The present study determined the cost-effectiveness of a community-based pulmonary rehabilitation program for COPD patients with mild, moderate, and severe disease. We compared the direct costs (in Canadian dollars) and disease-specific quality of life (measured by the St. George's Respiratory Questionnaire, SGRQ) of patients with COPD (N = 210) who enrolled in the rehabilitation program in Edmonton, Canada one year before and after completion of the program. To determine temporal trends in health service utilization between 2000 and 2002 we used similar data from 592 COPD patients from the same region who did not participate in the rehabilitation program. We found that the health status of patients enrolled in the program improved significantly following pulmonary rehabilitation, irrespective of the severity of disease (total SGRQ score improved by 4.85%, p = 0.001). The total direct cost per 100 person-years of follow-up before the program was $122,071 (SE = 29,566); after the program it was $87,704 (SE = 26,146). The average reduction of total costs before and after the program was $34,367 per 100 person-years or approximately $344 per person per year (p = 0.02). Over one-year, pulmonary rehabilitation was associated with decreased health service utilization, reduced direct costs and improved health status of COPD patients. This suggests that pulmonary rehabilitation is cost-effective for patients with relatively high utilization of emergency and hospital-based services.

Pulmonary Rehabilitation for Mild COPD: A Systematic Review

“…The agreement between the 2 authors was substantial (kappa ϭ 0.686, 95% CI 0.507-0.842, P ϭ .001). Results indicate that the quality of the studies varied among poor, 19 fair, 20 and good. 18 The 3 studies scored particularly poorly in the following items: description of adverse events, sample representativeness, patient and assessor blinding, adjustment for confounding factors in the analysis, and power.…”

“…18 The 3 studies recruited a total of 100 patients receiving specialized care. Golmohammadi et al 19 did not provide data on age and gender ratio of the 31 patients with mild COPD. In the other 2 studies, age ranged from 41 to 83 y, and the number of male patients included were approximately double the number of female patients (47: 22).…”

“…The included studies had different designs that included retrospective, 19 one-group pretest-posttest, 20 and randomized controlled. 18 The 3 studies recruited a total of 100 patients receiving specialized care.…”

“…The pulmonary rehabilitation programs implemented by Golmohammadi et al 19 and by Riario-Sforza et al 20 were both out-patient programs, with duration between 6 and 8 weeks and frequency between 2 and 3 sessions a week. The exercise training sessions lasted between 60 and 90 min, and included mainly aerobic training, strength training, and respiratory muscle training.…”

“…18,20 Significant improvements in exercise capacity were found when comparing pretest-posttest data (effect size (ES) 0.87) 20 and when comparing pulmonary rehabilitation with standard medical treatment (ES 1.82). 18 HRQOL HRQOL was measured in 2 studies using distinct instruments, that is, the St George Respiratory Questionnaire (SGRQ) 19 and the Zhongshan COPD questionnaire. 18 A small improvement in SGRQ symptoms (ES 0.34) and activity (ES 0.49) scores, and a medium improvement in SGRQ impact score (ES 0.66) were found after pulmonary rehabilitation.…”