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The Cost-Effectiveness of Pulmonary Rehabilitation for COPD in Different Settings: A Systematic Review

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Abstract

Background

Chronic obstructive pulmonary disease (COPD) has high morbidity and mortality rates. COPD impairs body functioning, reduces quality of life, and creates a great economic burden for society. Pulmonary rehabilitation (PR) has become an important nonpharmacological treatment for COPD. This paper systematically reviews economic evaluations of PR in COPD patients in different settings.

Objectives

We aimed to understand the cost-effectiveness of PR in different settings for COPD to provide economic evidence for decision-makers.

Methods

We searched eight databases from their inception to 23 November 2019. The results were presented in terms of an incremental cost-effectiveness ratio (ICER), and the decision uncertainty was expressed by cost-effectiveness acceptability curves (CEACs). We used the Consensus on Health Economic Criteria to assess study quality.

Results

This review included ten studies that matched the selection criteria. Five studies compared PR with usual care in primary healthcare or outpatient departments. Two studies compared community-based PR with hospital PR or usual care. In the other studies, PR was mainly carried out at home. Compared with usual care, PR was cost-effective in primary healthcare institutions or outpatient departments. According to CEACs, community-based PR had a 50% probability of cost-effectiveness at £30,000/quality-adjusted life year (QALY) compared with hospital PR in the UK. Based on the ICER, community-based PR was “moderately” cost-effective, with a ratio of €32,425/QALY compared with usual care in the Netherlands. Home-based PR was dominant compared with usual care, and tele-rehabilitation was dominant compared with traditional home PR.

Conclusions

PR conducted in different settings can potentially be cost-effective, as measured using QALY or the Chronic Respiratory Questionnaire (CRQ).

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References

  1. Zhu B, Wang Y, Ming J, Chen W, Zhang L. Disease burden of COPD in China: a systematic review. Int J Chron Obstruct Pulmon Dis. 2018;13:1353–64. https://doi.org/10.2147/COPD.S161555.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Miravitlles M, Ribera A. Understanding the impact of symptoms on the burden of COPD. Respir Res. 2017;18(1):67. https://doi.org/10.1186/s12931-017-0548-3.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chan SMH, Selemidis S, Bozinovski S et al. Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies. Pharmacol Therapeut. 2019;198:160–88. https://doi.org/10.1016/j.pharmthera.2019.02.013

    Article  CAS  Google Scholar 

  4. Soriano JB, Abajobir AA, Abate KH, Abera SF, Agrawal A, Ahmed MB, et al. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5(9):691–706. https://doi.org/10.1016/s2213-2600(17)30293-x.

    Article  Google Scholar 

  5. Blanco I, Diego I, Bueno P, Fernandez E, Casas-Maldonado F, Esquinas C, et al. Geographical distribution of COPD prevalence in Europe, estimated by an inverse distance weighting interpolation technique. Int J Chron Obstruct Pulmon Dis. 2018;13:57–67. https://doi.org/10.2147/COPD.S150853.

    Article  PubMed  Google Scholar 

  6. Souliotis K, Kousoulakou H, Hillas G, Tzanakis N, Toumbis M, Vassilakopoulos T. The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece. Int J Chron Obstruct Pulmon Dis. 2017;12:1395–400. https://doi.org/10.2147/COPD.S132825.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lisspers K, Larsson K, Johansson G, Janson C, Costa-Scharplatz M, Gruenberger JB, et al. Economic burden of COPD in a Swedish cohort: the ARCTIC study. Int J Chron Obstruct Pulmon Dis. 2018;13:275–85. https://doi.org/10.2147/COPD.S149633.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Foo J, Landis SH, Maskell J, Oh YM, van der Molen T, Han MK, et al. Continuing to confront COPD international patient survey: economic impact of COPD in 12 countries. PLoS One. 2016;11(4):e0152618. https://doi.org/10.1371/journal.pone.0152618.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13–64. https://doi.org/10.1164/rccm.201309-1634ST.

    Article  PubMed  Google Scholar 

  10. Li Y, Qian H, Yu K, Huang Y. Nonadherence in home-based pulmonary rehabilitation program for COPD patients. Can Respir J. 2020;2020:5146765. https://doi.org/10.1155/2020/5146765.

    Article  PubMed  PubMed Central  Google Scholar 

  11. de Araujo CLP, Pereira Reinaldo G, Foscarini BG, Ferreira Schneider B, Moraes Menezes VJ, Dal Lago P. The effects of pulmonary rehabilitation on endothelial function and arterial stiffness in patients with chronic obstructive pulmonary disease. Physiother Res Int. 2020;25(2):e1820. https://doi.org/10.1002/pri.1820.

    Article  Google Scholar 

  12. Candemir I, Ergun P, Kaymaz D, Demir N. Use of i-BODE index to determine efficacy of pulmonary rehabilitation in COPD patients. Tuberk Toraks. 2019;67(2):116–23. https://doi.org/10.5578/tt.68468.

    Article  PubMed  Google Scholar 

  13. Wu W, Liu X, Li P, Li N, Wang Z. Effect of liuzijue exercise combined with elastic band resistance exercise on patients with COPD: a randomized controlled trial. Evid Based Compl Alternat Med. 2018;2018:1–12.

    CAS  Google Scholar 

  14. Ozmen I, Yildirim E, Ozturk M, Ocakli B, Yildiz R, Aydin R, et al. Pulmonary rehabilitation reduces emergency admission and hospitalization rates of patients with chronic respiratory diseases. Turk Thorac J/türk Toraks Dergisi. 2018;19(4):170–5.

    Article  Google Scholar 

  15. Cecins N, Landers H, Jenkins S. Community-based pulmonary rehabilitation in a non-healthcare facility is feasible and effective. Chron Respir Dis. 2017;14(1):3–10. https://doi.org/10.1177/1479972316654287.

    Article  PubMed  Google Scholar 

  16. Pradella CO, Belmonte GM, Maia MN, Delgado CS, Luise AP, Nascimento OA, et al. Home-based pulmonary rehabilitation for subjects With COPD: a randomized study. Respir Care. 2015;60(4):526–32. https://doi.org/10.4187/respcare.02994.

    Article  PubMed  Google Scholar 

  17. Burns DK, Wilson EC, Browne P, Olive S, Clark A, Galey P, et al. The Cost effectiveness of maintenance schedules following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: an economic evaluation alongside a randomised controlled trial. Appl Health Econ Health Policy. 2016;14(1):105–15. https://doi.org/10.1007/s40258-015-0199-9.

    Article  PubMed  Google Scholar 

  18. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41. https://doi.org/10.1016/j.ijsu.2010.02.007.

    Article  PubMed  Google Scholar 

  19. Takura T, Ebata-Kogure N, Goto Y, Kohzuki M, Nagayama M, Oikawa K, et al. Cost-effectiveness of cardiac rehabilitation in patients with coronary artery disease: a meta-analysis. Cardiol Res Pract. 2019;2019:1840894. https://doi.org/10.1155/2019/1840894.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Roos JB, Doshi SN, Konorza T, Palacios I, Schreiber T, Borisenko OV, et al. The cost-effectiveness of a new percutaneous ventricular assist device for high-risk PCI patients: mid-stage evaluation from the European perspective. J Med Econ. 2013;16(3):381–90. https://doi.org/10.3111/13696998.2012.762004.

    Article  PubMed  Google Scholar 

  21. Evers S, Goossens M, de Vet H, van Tulder M, Ament A. Criteria list for assessment of methodological quality of economic evaluations: consensus on Health Economic Criteria. Int J Technol Assess Health Care. 2005;21(2):240–5.

    Article  Google Scholar 

  22. Gillespie P, O’Shea E, Casey D, Murphy K, Devane D, Cooney A, et al. The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial. BMJ Open. 2013;3(11):e003479. https://doi.org/10.1136/bmjopen-2013-003479.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Atsou K, Crequit P, Chouaid C, Hejblum G. Simulation-based estimates of the effectiveness and cost-effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease in France. PLoS One. 2016;11(6):e0156514. https://doi.org/10.1371/journal.pone.0156514.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Griffiths TL, Phillips CJ, Davies S, Burr ML, Campbell IA. Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax. 2001;56(10):779–84. https://doi.org/10.1136/thorax.56.10.779.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Goldstein RS, Gort EH, Guyatt GH, Feeny D. Economic analysis of respiratory rehabilitation. Chest. 1997;112(2):370–9. https://doi.org/10.1378/chest.112.2.370.

    Article  CAS  PubMed  Google Scholar 

  26. Waterhouse JC, Walters SJ, Oluboyede Y, Lawson RA. A randomised 2 × 2 trial of community versus hospital pulmonary rehabilitation, followed by telephone or conventional follow-up. Health Technol Assess. 2010;14(6):i–v, vii–xi, 1–140. https://doi.org/10.3310/hta14060.

  27. Hoogendoorn M, van Wetering CR, Schols AM, Rutten-van Molken MP. Is INTERdisciplinary COMmunity-based COPD management (INTERCOM) cost-effective? Eur Respir J. 2010;35(1):79–87. https://doi.org/10.1183/09031936.00043309.

    Article  CAS  PubMed  Google Scholar 

  28. Burge AT, Holland AE, McDonald CF, Abramson MJ, Hill CJ, Lee AL, et al. Home-based pulmonary rehabilitation for COPD using minimal resources: an economic analysis. Respirology. 2020;25(2):183–90. https://doi.org/10.1111/resp.13667.

    Article  PubMed  Google Scholar 

  29. Cox M, O’Connor C, Biggs K, Hind D, Bortolami O, Franklin M, et al. The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation. Health Technol Assess. 2018;22(11):1–204. https://doi.org/10.3310/hta22110.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Haesum LK, Soerensen N, Dinesen B, Nielsen C, Grann O, Hejlesen O, et al. Cost-utility analysis of a telerehabilitation program: a case study of COPD patients. Telemed J E Health. 2012;18(9):688–92. https://doi.org/10.1089/tmj.2011.0250.

    Article  PubMed  Google Scholar 

  31. Dutch Ministry of Health, Welfare and Sport. Advice for reasonable healthcare (in Dutch). The Hague, Dutch Ministry of Health, Welfare and Sport, 2006. http://www.rvz.net/data/download/advies_Zinnige_zorg.pdf. Accessed 20 Feb 2020.

  32. Bolton CE, Bevan-Smith EF, Blakey JD, Crowe P, Elkin SL, Garrod R et al. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax. 2013;68 Suppl 2:ii1–30. https://doi.org/10.1136/thoraxjnl-2013-203808.

  33. Pickard AS, Yang Y, Lee TA. Comparison of health-related quality of life measures in chronic obstructive pulmonary disease. Health Qual Life Outcomes. 2011;9:26. https://doi.org/10.1186/1477-7525-9-26.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Abedi Yekta AH, Poursaeid Esfahani M, Salehi S, Hassabi M, Khosravi S, Kharabian S, et al. Assessment of the effects of inspiratory muscle training (IMT) and aerobic training on the quality of life of patients with chronic obstructive pulmonary disease. Tanaffos. 2019;18(3):223–9.

    PubMed  PubMed Central  Google Scholar 

  35. Silva C, Gomes Neto M, Saquetto MB, Conceição CSD, Souza-Machado A. Effects of upper limb resistance exercise on aerobic capacity, muscle strength, and quality of life in COPD patients: a randomized controlled trial. Clin Rehabil. 2018;32(12):1636–44. https://doi.org/10.1177/0269215518787338.

    Article  PubMed  Google Scholar 

  36. Cannon D, Buys N, Sriram KB, Sharma S, Morris N, Sun J. The effects of chronic obstructive pulmonary disease self-management interventions on improvement of quality of life in COPD patients: a meta-analysis. Respir Med. 2016;121:81–90. https://doi.org/10.1016/j.rmed.2016.11.005.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, 130021, China

    Shengnan Liu, Wenshuo Li, Xuetong Zhao & Kun Li

  2. Orthopaedics Department, China-Japan Union Hospital of Jilin University, Changchun, China

    Qiheng Zhao

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Correspondence to Kun Li.

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Funding

This work was funded by Science and Technology Department of Jilin Province (20190303170SF); Health Commission of Jilin Province (2019J001).

Conflicts of interest

SL, QZ, WL, XZ and KL have no conflicts of interest to declare.

Data availability statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Authors’ contributions

The study conception and design were developed by SL, QZ and KL. Data collection and interpretation were performed by SL, QZ, WL and XZ. SL and QZ wrote the manuscript, which was critically reviewed by KL. All authors approved the version to be published.

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Not applicable.

Appendix 1: Search strategy

Appendix 1: Search strategy

PubMed search strategy

1

“Lung Diseases, Obstructive” OR “chronic obstructive pulmonary disease” OR “emphysema” OR “chronic obstructive airway disease” OR “COPD”

2

“pulmonary rehabilitation” OR “lung rehabilitation” OR “lung therapy” OR “pulmonary treatment” OR “rehabilitation program”

3

“costs” OR “cost-effectiveness analysis” OR “economics” OR “economic evaluation” OR “health care costs”

4

1 AND 2 AND 3

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Liu, S., Zhao, Q., Li, W. et al. The Cost-Effectiveness of Pulmonary Rehabilitation for COPD in Different Settings: A Systematic Review. Appl Health Econ Health Policy 19, 313–324 (2021). https://doi.org/10.1007/s40258-020-00613-5

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