Impacts of Chronic Obstructive Pulmonary Disease Care Pathway on Healthcare Utilization and Costs: A Matched Multiple Control Cohort Study in Saskatchewan, Canada

Kuwornu, John Paul; Maldonado, Fernando; Cooper, Elizabeth; Groot, Gary; Penz, Erika; Reid, Amy M.; Sommer, Lisa; Marciniuk, Darcy

doi:10.1016/j.jval.2023.04.013

Cited by 2 publications

(7 citation statements)

References 31 publications

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“…The COPD care pathway began as a collaborative project between various organizations, including the former Regina Qu’Appelle Health Region (RQHR), the Saskatchewan Health Quality Council (HQC), the LiveWELL COPD program [ 24 ] in the former Saskatoon Health Region, the University of Saskatchewan, Saskatchewan Ministry of Health, and Lung Saskatchewan. The pathway relies on care coordination between local primary care providers, respirologists, respiratory therapists, pharmacists and nurses; with the goals of increasing quality of care and reducing healthcare utilization [ 1 ]. The COPD care pathway was implemented in the former RQHR, now called Regina Area of the Saskatchewan Health Authority (SHA), in September 2017.…”

Section: Methodsmentioning

confidence: 99%

“…The COPD care pathway was implemented in the former RQHR, now called Regina Area of the Saskatchewan Health Authority (SHA), in September 2017. The COPD care pathway consists of a five-step process to provide coordinated patient navigation, including preventions programs, targeted screening, testing, diagnosis, and clinical management of the disease ( Table 1 ) [ 1 ].…”

Section: Methodsmentioning

confidence: 99%

“…Similar to our previous synthesis of the pertinent literature [ 1 ], two main issues crystalize from the overview of previous studies on the cost-effectiveness of COPD care pathways. First, except for one study [ 12 ], all previous studies reviewed presented “conventional” cost-effectiveness analyses.…”

Section: Introductionmentioning

confidence: 99%

“…One example of a chronic disease management program that is rising in popularity is the care pathway (also called the clinical pathway). A care pathway is a structured, multidisciplinary care plan with the following characteristics: a) translates guidelines or evidence into local structures, b) details the steps in a course of treatment or care in a plan, guideline, or protocol, and c) aims to standardize care for a specific clinical problem, procedure or episode of healthcare in a specific population [ 1 ]. Saskatchewan, a province in Canada with a population of 1.13 million (2021), has implemented care pathways for several common and resource-intensive health conditions, including prostate cancer, acute stroke, and more recently, chronic obstructive pulmonary disease (COPD).…”

Section: Introductionmentioning

confidence: 99%

“…Saskatchewan, a province in Canada with a population of 1.13 million (2021), has implemented care pathways for several common and resource-intensive health conditions, including prostate cancer, acute stroke, and more recently, chronic obstructive pulmonary disease (COPD). Despite the investments since 2009, there has not been a rigorous evaluation of the cost-effectiveness of care pathways in the province [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

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An economic evaluation of chronic obstructive pulmonary disease clinical pathway in Saskatchewan, Canada: Data-driven techniques to identify cost-effectiveness among patient subgroups

Kuwornu,

Maldonado,

Groot

et al. 2024

PLoS ONE

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Background Saskatchewan has implemented care pathways for several common health conditions. To date, there has not been any cost-effectiveness evaluation of care pathways in the province. The objective of this study was to evaluate the real-world cost-effectiveness of a chronic obstructive pulmonary disease (COPD) care pathway program in Saskatchewan. Methods Using patient-level administrative health data, we identified adults (35+ years) with COPD diagnosis recruited into the care pathway program in Regina between April 1, 2018, and March 31, 2019 (N = 759). The control group comprised adults (35+ years) with COPD who lived in Saskatoon during the same period (N = 759). The control group was matched to the intervention group using propensity scores. Costs were calculated at the patient level. The outcome measure was the number of days patients remained without experiencing COPD exacerbation within 1-year follow-up. Both manual and data-driven policy learning approaches were used to assess heterogeneity in the cost-effectiveness by patient demographic and disease characteristics. Bootstrapping was used to quantify uncertainty in the results. Results In the overall sample, the estimates indicate that the COPD care pathway was not cost-effective using the willingness to pay (WTP) threshold values in the range of $1,000 and $5,000/exacerbation day averted. The manual subgroup analyses show the COPD care pathway was dominant among patients with comorbidities and among patients aged 65 years or younger at the WTP threshold of $2000/exacerbation day averted. Although similar profiles as those identified in the manual subgroup analyses were confirmed, the data-driven policy learning approach suggests more nuanced demographic and disease profiles that the care pathway would be most appropriate for. Conclusions Both manual subgroup analysis and data-driven policy learning approach showed that the COPD care pathway consistently produced cost savings and better health outcomes among patients with comorbidities or among those relatively younger. The care pathway was not cost-effective in the entire sample.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An economic evaluation of chronic obstructive pulmonary disease clinical pathway in Saskatchewan, Canada: Data-driven techniques to identify cost-effectiveness among patient subgroups

Kuwornu,

Maldonado,

Groot

et al. 2024

PLoS ONE

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Real-World Cost-Consequence Analysis of an Integrated Chronic Disease Management Program in Saskatchewan, Canada

Kuwornu,

Maldonado,

Groot

et al. 2024

Health�Serv�Insights

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An integrated disease management program otherwise called a clinical pathway was recently implemented in Saskatchewan, Canada for patients living with chronic obstructive pulmonary disease (COPD). This study compared the real-world costs and consequences of the COPD clinical pathway program with 2 control treatment programs. The study comprised adult COPD patients in Regina (clinical pathway group, N = 759) matched on propensity scores to 2 independent control groups of similar adults in (1) Regina (historical controls, N = 759) and (2) Saskatoon (contemporaneous controls, N = 759). The study measures included patient-level healthcare costs and acute COPD exacerbation outcomes, both tracked in population-based administrative health data over a one-year follow-up period. Analyses included Cox proportional hazards models and differences in means between groups. The bias-corrected and accelerated bootstrap method was used to calculate 95% confidence intervals (CI). The COPD pathway patients had lower risks of moderate (hazard ratio [HR] =0.57, 95% CI [0.40-0.83]) and severe (HR = 0.43, 95% CI [0.28-0.66]) exacerbations compared to the historical control group, but similar risks compared with the contemporaneous control group. The COPD pathway patients experienced fewer episodes of exacerbations compared with the historical control group (mean difference = −0.30, 95% CI [−0.40, −0.20]) and the contemporaneous control group (mean difference = −0.12, 95% CI [−0.20, −0.03]). Average annual healthcare costs in Canadian dollars were marginally higher among patients in the COPD clinical pathway (mean = $10 549, standard deviation [SD] =$18 149) than those in the contemporaneous control group ($8841, SD = $17 120), but comparable to the historical control group ($10 677, SD = $21 201). The COPD pathway provides better outcomes at about the same costs when compared to the historical controls, but only slightly better outcomes and at a marginally higher cost when compared to the contemporaneous controls.

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Impacts of Chronic Obstructive Pulmonary Disease Care Pathway on Healthcare Utilization and Costs: A Matched Multiple Control Cohort Study in Saskatchewan, Canada

Cited by 2 publications

References 31 publications

An economic evaluation of chronic obstructive pulmonary disease clinical pathway in Saskatchewan, Canada: Data-driven techniques to identify cost-effectiveness among patient subgroups

An economic evaluation of chronic obstructive pulmonary disease clinical pathway in Saskatchewan, Canada: Data-driven techniques to identify cost-effectiveness among patient subgroups

Real-World Cost-Consequence Analysis of an Integrated Chronic Disease Management Program in Saskatchewan, Canada

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