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Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial

BACKGROUND: Appropriate management of chronic obstructive pulmonary disease (COPD) patients following acute exacerbations can reduce the risk of future exacerbations, improve health status, and lower care costs. While a transition care bundle (TCB) was associated with lower readmissions to hospitals...

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Autores principales: Yan, Charles, Round, Jeff, Akpinar, Ilke, Atwood, Chantal E., Deuchar, Lesly, Bhutani, Mohit, Leigh, Richard, Stickland, Michael K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10169973/
https://www.ncbi.nlm.nih.gov/pubmed/36905535
http://dx.doi.org/10.1007/s41669-023-00400-7
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author Yan, Charles
Round, Jeff
Akpinar, Ilke
Atwood, Chantal E.
Deuchar, Lesly
Bhutani, Mohit
Leigh, Richard
Stickland, Michael K.
author_facet Yan, Charles
Round, Jeff
Akpinar, Ilke
Atwood, Chantal E.
Deuchar, Lesly
Bhutani, Mohit
Leigh, Richard
Stickland, Michael K.
author_sort Yan, Charles
collection PubMed
description BACKGROUND: Appropriate management of chronic obstructive pulmonary disease (COPD) patients following acute exacerbations can reduce the risk of future exacerbations, improve health status, and lower care costs. While a transition care bundle (TCB) was associated with lower readmissions to hospitals than usual care (UC), it remains unclear whether the TCB was associated with cost savings. OBJECTIVE: The aim of this study was to evaluate how this TCB was associated with future Emergency Department (ED)/outpatient visits, hospital readmissions, and costs in Alberta, Canada. METHODS: Patients who were aged 35 years or older, who were admitted to hospital for a COPD exacerbation, and had not been treated with a care bundle received either TCB or UC. Those who received the TCB were then randomized to either TCB alone or TCB enhanced with a care coordinator. Data collected were ED/outpatient visits, hospital admissions and associated resources used for index admissions, and 7-, 30- and 90-day post-index discharge. A decision model with a 90-day time horizon was developed to estimate the cost. A generalized linear regression was conducted to adjust for imbalance in patient characteristics and comorbidities, and a sensitivity analysis was conducted on the proportion of patients’ combined ED/outpatient visits and inpatient admissions as well as the use of a care coordinator. RESULTS: Differences in length of stay (LOS) and costs between groups were statistically significant, although with some exceptions. Inpatient LOS and costs were 7.1 days (95% confidence interval [CI] 6.9–7.3) and Canadian dollars (CAN$) 13,131 (95% CI CAN$12,969–CAN$13,294) in UC, 6.1 days (95% CI 5.8–6.5) and CAN$7634 (95% CI CAN$7546–CAN$7722) in TCB with a coordinator, and 5.9 days (95% CI 5.6–6.2) and CAN$8080 (95% CI CAN$7975–CAN$8184) in TCB without a coordinator. Decision modelling indicated TCB was less costly than UC, with a mean (standard deviation [SD]) of CAN$10,172 (40) versus CAN$15,588 (85), and TCB with a coordinator was slightly less costly than without a coordinator (CAN$10,109 [49] versus CAN$10,244 [57]). CONCLUSION: This study suggests that the use of the TCB, with or without a care coordinator, appears to be an economically attractive intervention compared with UC. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s41669-023-00400-7.
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spelling pubmed-101699732023-05-11 Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial Yan, Charles Round, Jeff Akpinar, Ilke Atwood, Chantal E. Deuchar, Lesly Bhutani, Mohit Leigh, Richard Stickland, Michael K. Pharmacoecon Open Original Research Article BACKGROUND: Appropriate management of chronic obstructive pulmonary disease (COPD) patients following acute exacerbations can reduce the risk of future exacerbations, improve health status, and lower care costs. While a transition care bundle (TCB) was associated with lower readmissions to hospitals than usual care (UC), it remains unclear whether the TCB was associated with cost savings. OBJECTIVE: The aim of this study was to evaluate how this TCB was associated with future Emergency Department (ED)/outpatient visits, hospital readmissions, and costs in Alberta, Canada. METHODS: Patients who were aged 35 years or older, who were admitted to hospital for a COPD exacerbation, and had not been treated with a care bundle received either TCB or UC. Those who received the TCB were then randomized to either TCB alone or TCB enhanced with a care coordinator. Data collected were ED/outpatient visits, hospital admissions and associated resources used for index admissions, and 7-, 30- and 90-day post-index discharge. A decision model with a 90-day time horizon was developed to estimate the cost. A generalized linear regression was conducted to adjust for imbalance in patient characteristics and comorbidities, and a sensitivity analysis was conducted on the proportion of patients’ combined ED/outpatient visits and inpatient admissions as well as the use of a care coordinator. RESULTS: Differences in length of stay (LOS) and costs between groups were statistically significant, although with some exceptions. Inpatient LOS and costs were 7.1 days (95% confidence interval [CI] 6.9–7.3) and Canadian dollars (CAN$) 13,131 (95% CI CAN$12,969–CAN$13,294) in UC, 6.1 days (95% CI 5.8–6.5) and CAN$7634 (95% CI CAN$7546–CAN$7722) in TCB with a coordinator, and 5.9 days (95% CI 5.6–6.2) and CAN$8080 (95% CI CAN$7975–CAN$8184) in TCB without a coordinator. Decision modelling indicated TCB was less costly than UC, with a mean (standard deviation [SD]) of CAN$10,172 (40) versus CAN$15,588 (85), and TCB with a coordinator was slightly less costly than without a coordinator (CAN$10,109 [49] versus CAN$10,244 [57]). CONCLUSION: This study suggests that the use of the TCB, with or without a care coordinator, appears to be an economically attractive intervention compared with UC. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s41669-023-00400-7. Springer International Publishing 2023-03-11 /pmc/articles/PMC10169973/ /pubmed/36905535 http://dx.doi.org/10.1007/s41669-023-00400-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research Article
Yan, Charles
Round, Jeff
Akpinar, Ilke
Atwood, Chantal E.
Deuchar, Lesly
Bhutani, Mohit
Leigh, Richard
Stickland, Michael K.
Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial
title Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial
title_full Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial
title_fullStr Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial
title_full_unstemmed Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial
title_short Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial
title_sort cost analysis of a transition care bundle compared with usual care for copd patients being discharged from hospital: evaluation of a randomized controlled trial
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10169973/
https://www.ncbi.nlm.nih.gov/pubmed/36905535
http://dx.doi.org/10.1007/s41669-023-00400-7
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