Costs and benefits of Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: a randomized controlled trial

Abstract

ObjectiveThe current study evaluated the costs and benefits of a simple aerobic walking program for patients with chronic obstructive pulmonary disease (COPD). MethodThis was a blinded randomized controlled clinical trial that recruited 72 patients diagnosed with COPD, 40 of whom were included in the study and divided into two groups [control group (CG) and pulmonary rehabilitation group (GPR)]. We assessed pulmonary function, distance covered during the 6-minute walk test (6MWT), respiratory and peripheral muscle strength, health-related quality of life (HRQOL), body composition, and level of activities of daily living (ADLs) before and after an 8-week walking program. The financial costs were calculated according to the pricing table of the Brazilian Unified Health System (SUS). ResultsOnly 34 of the 40 patients remained in the final sample; 16 in the CG and 18 in the GPR (FEV1: 50.9±14% predicted and FEV1: 56±0.5% predicted, respectively). The intervention group exhibited improvements in the 6MWT, sensation of dyspnea and fatigue, work performed, BODE index (p<0.01), HRQOL, ADL level (p<0.001), and lower limb strength (p<0.05). The final mean cost per patient for the GPR was R$ 148.75 (~US$ 75.00) and no patient significantly exceeded this value. However, 2 patients in the CG did exceed this value, incurring a cost of R$ 689.15 (~US$ 345.00). ConclusionAerobic walking demonstrated significant clinical benefits in a cost-efficient manner in patients with COPD.

Locomotor Muscles in COPD: The Rationale for Rehabilitative Exercise Training

“…Muscle mass increased in the lower limbs (+8.5%) following an 8-week walking-based endurance training program (Farias et al, 2014) but this was not found after 12 weeks of constantload (80% WR peak ) endurance cycling (Bernard et al, 1999). Beyond the different mode of exercise, participants performed 5 vs. 3 weekly sessions, respectively, while each session was twice longer in the former study (i.e., up to 60 min vs. 30 min).…”

Home‐based pulmonary rehabilitation for COPD using minimal resources: An economic analysis

“…No previous economic analysis of pulmonary rehabilitation has compared a home‐based model to a centre‐based programme. Past work has been purely descriptive, comparing centre‐based programmes to usual care or comparing two different models of centre‐based pulmonary rehabilitation (hospital versus community centre) . Our analysis used individual‐level data collected as part of an RCT, undertaken with reference to economic evaluation recommendations and reflecting a ‘real‐life’ clinical setting.…”

Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings

“…Fiftysix articles were reviewed in full text, with 43 articles excluded. Thirteen articles met the review criteria and were included [35][36][37][38][39][40][41][42][43][44][45][46][47] . No additional papers were identified in the pre-publication update.…”

“…Study participants were COPD patients 35,[37][38][39][40][41][42][43][44][45][46][47] of varying degree of severity in all the trials except one which recruited people with pulmonary impairment after TB (PIAT) 36 . Total number of enrolled participants was 661 of which COPD and PIAT were 83% and 17%, respectively.…”

“…The trials were conducted in Turkey (n = 4) 35,39,40,43 , Brazil (n = 3) 37,41,46 , India (n = 2) 38,47 , Egypt (n = 1) 42 , Iran (n = 1), 44 South Africa (n = 1) 36 , and Venezuela (n = 1) 45 .…”