Operational Modeling with Health Economics to Support Decision Making for COPD Patients

Abstract

Objective To assess the impact of interventions for improving the management of chronic obstructive pulmonary disease (COPD), specifically increased use of pulmonary rehabilitation (PR) on patient outcomes and cost‐benefit analysis. Data Sources We used the national Hospital Episode Statistics (HES) datasets in England, local data and experts from the hospital setting, National Prices and National Tariffs, reports and the literature around the effectiveness of PR programs. Study Design The COPD pathway was modeled using discrete event simulation (DES) to capture the patient pathway to an adequate level of detail as well as randomness in the real world. DES was further enhanced by the integration of a health economic model to calculate the net benefit and cost of treating COPD patients based on key sets of interventions. Data Collection/Extraction Methods A total of 150 input parameters and 75 distributions were established to power the model using the HES dataset, outpatient activity data from the hospital and community services, and the literature. Principal Findings The simulation model showed that increasing referral to PR (by 10%, 20%, or 30%) would be cost‐effective (with a benefit‐cost ratio of 5.81, 5.95, and 5.91, respectively) by having a positive impact on patient outcomes and operational metrics. Number of deaths, admissions, and bed days decreased (ie, by 3.56 patients, 4.90 admissions, and 137.31 bed days for a 30% increase in PR referrals) as well as quality of life increased (ie, by 5.53 QALY among 1540 patients for the 30% increase). Conclusions No operational model, either statistical or simulation, has previously been developed to capture the COPD patient pathway within a hospital setting. To date, no model has investigated the impact of PR on COPD services, such as operations, key performance, patient outcomes, and cost‐benefit analysis. The study will support policies around extending availability of PR as a major intervention.

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

“…Compared to usual care, pulmonary rehabilitation leads to substantial improvements in dyspnea, exercise capacity, and health status [ 25 ]. Furthermore, when provided following hospitalizations for COPD exacerbation, it has pronounced benefit in reducing subsequent hospitalization and mortality risk [ 55 ], and referral leads to projected favorable benefit–cost analyses, both from a systematic review [ 56 ], and across different health care settings in the United Kingdom [ 57 ].…”

A discrete event simulation for improving operating theatre efficiency

“…In the last 2 decades there has been an explosive increase in the number of DES publications and a claimed diffusion of DES into healthcare 8 . It has been observed that the applications of DES are largely confined to specific health care units, with modelling of emergency departments the most popular setting 9,10 and many applications seeking to improve time‐ and efficiency‐related metrics 9,11 and cost‐effectiveness 12 . A recent systematic review found an increasing trend towards using DES in healthcare to address issues at an operational level, yet less than 10% of DES applications presented actual implementations following the modelling stage 9 .…”

“…8 It has been observed that the applications of DES are largely confined to specific health care units, with modelling of emergency departments the most popular setting 9,10 and many applications seeking to improve time-and efficiency-related metrics 9,11 and cost-effectiveness. 12 A recent systematic review found an increasing trend towards using DES in healthcare to address issues at an operational level, yet less than 10% of DES applications presented actual implementations following the modelling stage. 9 The review advocates that future research should focus on the implementation of models, overcoming critical barriers such as security and privacy and obtaining acceptance for change from healthcare professionals.…”

Cost-effectiveness of Pulmonary Rehabilitation Among US Adults With Chronic Obstructive Pulmonary Disease

“…33 Although it is reassuring that these prior results are consistent with our present findings, our study has several important differences. In addition to including routinely reported costs of PR, rehospitalization, and ED use, [17][18][19]34 we included the costs of SNF days, which to date have been reported infrequently (Table 1). In addition, we included data from multiple large data sources using clinical evidence, 10,11 in contrast to most prior studies that used single-center clinical trial data.…”