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The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial
OBJECTIVE: To assess the cost-effectiveness of a structured education pulmonary rehabilitation programme (SEPRP) for chronic obstructive pulmonary disease (COPD) relative to usual practice in primary care. The programme consisted of group-based sessions delivered jointly by practice nurses and physi...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845253/ https://www.ncbi.nlm.nih.gov/pubmed/24282243 http://dx.doi.org/10.1136/bmjopen-2013-003479 |
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author | Gillespie, Paddy O'Shea, Eamon Casey, Dympna Murphy, Kathy Devane, Declan Cooney, Adeline Mee, Lorraine Kirwan, Collette McCarthy, Bernard Newell, John |
author_facet | Gillespie, Paddy O'Shea, Eamon Casey, Dympna Murphy, Kathy Devane, Declan Cooney, Adeline Mee, Lorraine Kirwan, Collette McCarthy, Bernard Newell, John |
author_sort | Gillespie, Paddy |
collection | PubMed |
description | OBJECTIVE: To assess the cost-effectiveness of a structured education pulmonary rehabilitation programme (SEPRP) for chronic obstructive pulmonary disease (COPD) relative to usual practice in primary care. The programme consisted of group-based sessions delivered jointly by practice nurses and physiotherapists over 8 weeks. DESIGN: Cost-effectiveness and cost-utility analysis alongside a cluster randomised controlled trial. SETTING: 32 general practices in Ireland. PARTICIPANTS: 350 adults with COPD, 69% of whom were moderately affected. INTERVENTIONS: Intervention arm (n=178) received a 2 h group-based SEPRP session per week over 8 weeks delivered jointly by a practice nurse and physiotherapist at the practice surgery or nearby venue. The control arm (n=172) received the usual practice in primary care. MAIN OUTCOME MEASURES: Incremental costs, Chronic Respiratory Questionnaire (CRQ) scores, quality-adjusted life years (QALYs) gained estimated using the generic EQ5D instrument, and expected cost-effectiveness at 22 weeks trial follow-up. RESULTS: The intervention was associated with an increase of €944 (95% CIs 489 to 1400) in mean healthcare cost and €261 (95% CIs 226 to 296) in mean patient cost. The intervention was associated with a mean improvement of 1.11 (95% CIs 0.35 to 1.87) in CRQ Total score and 0.002 (95% CIs −0.006 to 0.011) in QALYs gained. These translated into incremental cost-effectiveness ratios of €850 per unit increase in CRQ Total score and €472 000 per additional QALY gained. The probability of the intervention being cost-effective at respective threshold values of €5000, €15 000, €25 000, €35 000 and €45 000 was 0.980, 0.992, 0.994, 0.994 and 0.994 in the CRQ Total score analysis compared to 0.000, 0.001, 0.001, 0.003 and 0.007 in the QALYs gained analysis. CONCLUSIONS: While analysis suggests that SEPRP was cost-effective if society is willing to pay at least €850 per one-point increase in disease-specific CRQ, no evidence exists when effectiveness was measured in QALYS gained. TRIAL REGISTRATION: Current Controlled Trials ISRCTN52 403 063. |
format | Online Article Text |
id | pubmed-3845253 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-38452532013-12-02 The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial Gillespie, Paddy O'Shea, Eamon Casey, Dympna Murphy, Kathy Devane, Declan Cooney, Adeline Mee, Lorraine Kirwan, Collette McCarthy, Bernard Newell, John BMJ Open Health Economics OBJECTIVE: To assess the cost-effectiveness of a structured education pulmonary rehabilitation programme (SEPRP) for chronic obstructive pulmonary disease (COPD) relative to usual practice in primary care. The programme consisted of group-based sessions delivered jointly by practice nurses and physiotherapists over 8 weeks. DESIGN: Cost-effectiveness and cost-utility analysis alongside a cluster randomised controlled trial. SETTING: 32 general practices in Ireland. PARTICIPANTS: 350 adults with COPD, 69% of whom were moderately affected. INTERVENTIONS: Intervention arm (n=178) received a 2 h group-based SEPRP session per week over 8 weeks delivered jointly by a practice nurse and physiotherapist at the practice surgery or nearby venue. The control arm (n=172) received the usual practice in primary care. MAIN OUTCOME MEASURES: Incremental costs, Chronic Respiratory Questionnaire (CRQ) scores, quality-adjusted life years (QALYs) gained estimated using the generic EQ5D instrument, and expected cost-effectiveness at 22 weeks trial follow-up. RESULTS: The intervention was associated with an increase of €944 (95% CIs 489 to 1400) in mean healthcare cost and €261 (95% CIs 226 to 296) in mean patient cost. The intervention was associated with a mean improvement of 1.11 (95% CIs 0.35 to 1.87) in CRQ Total score and 0.002 (95% CIs −0.006 to 0.011) in QALYs gained. These translated into incremental cost-effectiveness ratios of €850 per unit increase in CRQ Total score and €472 000 per additional QALY gained. The probability of the intervention being cost-effective at respective threshold values of €5000, €15 000, €25 000, €35 000 and €45 000 was 0.980, 0.992, 0.994, 0.994 and 0.994 in the CRQ Total score analysis compared to 0.000, 0.001, 0.001, 0.003 and 0.007 in the QALYs gained analysis. CONCLUSIONS: While analysis suggests that SEPRP was cost-effective if society is willing to pay at least €850 per one-point increase in disease-specific CRQ, no evidence exists when effectiveness was measured in QALYS gained. TRIAL REGISTRATION: Current Controlled Trials ISRCTN52 403 063. BMJ Publishing Group 2013-11-25 /pmc/articles/PMC3845253/ /pubmed/24282243 http://dx.doi.org/10.1136/bmjopen-2013-003479 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/ |
spellingShingle | Health Economics Gillespie, Paddy O'Shea, Eamon Casey, Dympna Murphy, Kathy Devane, Declan Cooney, Adeline Mee, Lorraine Kirwan, Collette McCarthy, Bernard Newell, John The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial |
title | The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial |
title_full | The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial |
title_fullStr | The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial |
title_full_unstemmed | The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial |
title_short | The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial |
title_sort | cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the prince cluster randomised trial |
topic | Health Economics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845253/ https://www.ncbi.nlm.nih.gov/pubmed/24282243 http://dx.doi.org/10.1136/bmjopen-2013-003479 |
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