The health economic impact of disease management programs for COPD: a systematic literature review and meta-analysis

Abstract

BackgroundThere is insufficient evidence of the cost-effectiveness of Chronic Obstructive Pulmonary Disease (COPD) Disease Management (COPD-DM) programs. The aim of this review is to evaluate the economic impact of COPD-DM programs and investigate the relation between the impact on healthcare costs and health outcomes. We also investigated the impact of patient-, intervention, and study-characteristics.MethodsWe conducted a systematic literature review to identify cost-effectiveness studies of COPD-DM. Where feasible, results were pooled using random-effects meta-analysis and explorative subgroup analyses were performed.ResultsSixteen papers describing 11 studies were included (7 randomized control trials (RCT), 2 pre-post, 2 case–control). Meta-analysis showed that COPD-DM led to hospitalization savings of €1060 (95% CI: €2040 to €80) per patient per year and savings in total healthcare utilization of €898 (95% CI: €1566 to €231) (excl. operating costs). In these health economic studies small but positive results on health outcomes were found, such as the St Georges Respiratory Questionnaire (SGRQ) score, which decreased with 1.7 points (95% CI: 0.5-2.9). There was great variability in DM interventions-, study- and patient-characteristics. There were indications that DM showed greater savings in studies with: severe COPD patients, patients with a history of exacerbations, RCT study design, high methodological quality, few different professions involved in the program, and study setting outside Europe.ConclusionsCOPD-DM programs were found to have favourable effects on both health outcomes and costs, but there is considerable heterogeneity depending on patient-, intervention-, and study-characteristics.

Delivery of care for functional gastrointestinal disorders: A systematic review

“…These programs aim to coordinate guideline-informed outpatient care for patients with chronic diseases. 38,39 Chronic disease management programs also address hospital readmissions and mortality, although these are not important issues for FGIDs. 36 Similar programs in diabetes, 37 chronic obstructive pulmonary disease, and cirrhosis care have shown similar improved outcomes.…”

The Role of Pulmonology in the National Health System Chronicity Strategy

“…Three systematic reviews have shown clinical benefits, finding a significant reduction in both exacerbations requiring medical attention, and in the frequency of hospitalizations, improvements in exercise tolerance and shorter hospital stays. [16][17][18] In a fourth meta-analysis, Boland et al 19 also showed a reduction in direct costs, with savings of D 1060 (95% CI: D 80-D 2040) per patient and year in hospitalization costs and D 898 (95% CI: D 231-D 1566) in costs derived from the use of healthcare services. However, the heterogeneity of the interventions, with underpowered pilot studies, and the scant methodological use of clinical trials make it difficult to draw definitive conclusions.…”

Towards High Quality Health Care and Sustainable Financing – the Role of Health Care Programmes

“…; Brady, ; de Bruin et al., Dongbo et al., ; 2011; Tsiachristas et al., ; Boland et al. ; van Steenbergen‐Weijenburg et al., ).…”