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

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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.


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


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.


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.


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

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Corresponding author

Correspondence to Kun Li.

Ethics declarations


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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Appendix 1: Search strategy

Appendix 1: Search strategy

PubMed search strategy


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


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


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


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).

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