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

Liu, Shengnan; Zhao, Qin; Li, Wenshuo; Zhao, Xuetong; Li, Kun

doi:10.1007/s40258-020-00613-5

Cited by 26 publications

(21 citation statements)

References 33 publications

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“…Compared to usual care, pulmonary rehabilitation leads to substantial improvements in dyspnea, exercise capacity, and health status [ 25 ]. Furthermore, when provided following hospitalizations for COPD exacerbation, it has pronounced benefit in reducing subsequent hospitalization and mortality risk [ 55 ], and referral leads to projected favorable benefit–cost analyses, both from a systematic review [ 56 ], and across different health care settings in the United Kingdom [ 57 ].…”

Section: Telemedicinementioning

confidence: 99%

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

2021

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Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new.

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Section: Telemedicinementioning

confidence: 99%

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

2021

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“…We were unable to identify any previously published cost-effectiveness analyses of PR for patients with COPD in the US health care system, although our findings are supported by numerous non-US studies (eTable 2 in the Supplement). [16][17][18][19] A systematic review by Liu et al 33 found that PR was cost-effective across a variety of settings, including outpatient and home-based rehabilitation and telerehabilitation. 33 Although it is reassuring that these prior results are consistent with our present findings, our study has several important differences.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19] A systematic review by Liu et al 33 found that PR was cost-effective across a variety of settings, including outpatient and home-based rehabilitation and telerehabilitation. 33 Although it is reassuring that these prior results are consistent with our present findings, our study has several important differences. In addition to including routinely reported costs of PR, rehospitalization, and ED use, [17][18][19]34 we included the costs of SNF days, which to date have been reported infrequently (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Pulmonary Rehabilitation Among US Adults With Chronic Obstructive Pulmonary Disease

et al. 2022

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IMPORTANCE Pulmonary rehabilitation (PR) after exacerbation of chronic obstructive pulmonary disease (COPD) is effective in reducing COPD hospitalizations and mortality while improving healthrelated quality of life, yet use of PR remains low. Estimates of the cost-effectiveness of PR in this setting could inform policies to improve uptake. OBJECTIVE To estimate the cost-effectiveness of participation in PR after hospitalization for COPD. DESIGN, SETTING, AND PARTICIPANTSThis economic evaluation estimated the costeffectiveness of participation in PR compared with no PR after COPD hospitalization in the US using a societal perspective analysis. A Markov microsimulation model was developed to estimate the costeffectiveness in the US health care system with a lifetime horizon, 1-year cycle length, and a discounted rate of 3% per year for both costs and outcomes. Data sources included published

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“…Participants hypothesised that if the intervention improves health outcomes, it may save the healthcare system money in the long-term. This hypothesis is supported for in-person interventions and some eHealth interventions for people with chronic diseases [41][42][43][44]. A recent economic analysis of a 6-month lifestyle-focused text message intervention for secondary prevention of CVD found that reduced hospitalisations due to interventioninduced health improvements could save the government nearly $10Million [13].…”

Section: Discussionmentioning

confidence: 91%

Supporting breast cancer survivors via text messages: reach, acceptability, and utility of EMPOWER-SMS

et al. 2021

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Purpose This study aims to evaluate the reach, usefulness, acceptability, and factors influencing engagement with a lifestylefocused text message intervention to support women's mental and physical health after breast cancer treatment. Methods This study uses a mixed-methods process evaluation nested in the EMPOWER-SMS randomised controlled trial (n = 160; intervention n = 80, wait-list control n = 80). Data sources included screening logs, text message delivery software analytics, intervention feedback survey, and focus groups (n = 16), which were summarised thematically based on the framework approach. Results A total of 387 women met the inclusion criteria (mean age ± SD = 59.3 ± 11.6 years). Participants who declined (n = 227) were significantly older than those who enrolled (n = 160; 62.2 ± 11.1 vs 55.1 ± 11.1 years, respectively, p < 0.001). Most intervention participants (64/80; 80%) completed the end-of-study survey, reporting the messages were easy to understand (64/64; 100%), useful (58/64; 91%), and motivating (43/64; 67%). The focus groups (n = 16) revealed five factors influencing engagement: (i) feelings of support/continued care, (ii) convenience/flexibility of message delivery, (iii) weblinks, (iv) information from a credible source, and (v) options to save or share messages. Conclusion A lifestyle-focused text message program was acceptable and useful for women after breast cancer treatment.However, text messaging may be a barrier for women aged over 68 years. Suggestions for program improvements included delivering the program to patients with other cancers, during all stages of treatment, and including more weblinks in text messages. Implications for Cancer Survivors Text message programs offer a low-cost way to deliver post-treatment health support to breast cancer survivors in a noninvasive way. Text messages can improve patient-health professional communication and were found to be acceptable and useful.

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

Cited by 26 publications

References 33 publications

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

Cost-effectiveness of Pulmonary Rehabilitation Among US Adults With Chronic Obstructive Pulmonary Disease

Supporting breast cancer survivors via text messages: reach, acceptability, and utility of EMPOWER-SMS

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