The health economic impact of disease management programs for COPD: a systematic literature review and meta-analysis

BMC Pulmonary Medicine

Maureen PMH Rutten-van Mölken¹  Niels H Chavannes²  Annemarije L Kruis²  Apostolos Tsiachristas¹  Melinde RS Boland¹ 

[1] Department of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands;Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands

关键词: Economic evaluation;    COPD;    Disease management;    Integrated care;    Review;    Meta-analysis;    Costs;    Cost-effectiveness;    Efficiency;    Chronic obstructive pulmonary disease;   

Others  :  1122315
DOI  :  10.1186/1471-2466-13-40

 received in 2012-10-26, accepted in 2013-06-18,  发布年份 2013

【 摘 要 】

Background

There is insufficient evidence of the cost-effectiveness of Chronic Obstructive Pulmonary Disease (COPD) Disease Management (COPD-DM) programs. The aim of this review is to evaluate the economic impact of COPD-DM programs and investigate the relation between the impact on healthcare costs and health outcomes. We also investigated the impact of patient-, intervention, and study-characteristics.

Methods

We conducted a systematic literature review to identify cost-effectiveness studies of COPD-DM. Where feasible, results were pooled using random-effects meta-analysis and explorative subgroup analyses were performed.

Results

Sixteen papers describing 11 studies were included (7 randomized control trials (RCT), 2 pre-post, 2 case–control). Meta-analysis showed that COPD-DM led to hospitalization savings of €1060 (95% CI: €2040 to €80) per patient per year and savings in total healthcare utilization of €898 (95% CI: €1566 to €231) (excl. operating costs). In these health economic studies small but positive results on health outcomes were found, such as the St Georges Respiratory Questionnaire (SGRQ) score, which decreased with 1.7 points (95% CI: 0.5-2.9). There was great variability in DM interventions-, study- and patient-characteristics. There were indications that DM showed greater savings in studies with: severe COPD patients, patients with a history of exacerbations, RCT study design, high methodological quality, few different professions involved in the program, and study setting outside Europe.

Conclusions

COPD-DM programs were found to have favourable effects on both health outcomes and costs, but there is considerable heterogeneity depending on patient-, intervention-, and study-characteristics.

【 授权许可】

   
2013 Boland et al.; licensee BioMed Central Ltd.

【 图 表 】

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