Cost-Effectiveness of Pulmonary Rehabilitation in Patients With Bronchial Asthma: An Analysis of the EPRA Randomized Controlled Trial

Boeckmann, Denise; Szentes, Boglarka Lilla; Schultz, Konrad; Nowak, Dirk; Schuler, Michael und Schwarzkopf, Larissa (2021): Cost-Effectiveness of Pulmonary Rehabilitation in Patients With Bronchial Asthma: An Analysis of the EPRA Randomized Controlled Trial. In: Value in Health, Bd. 24, Nr. 9: S. 1254-1262

Abstract

Objectives: At 3 months after the intervention, this study evaluates the cost-effectiveness of a 3-week inpatient pulmonary rehabilitation (PR) in patients with asthma compared with usual care alongside the single-center randomized controlled trial-Effectiveness of Pulmonary Rehabilitation in Patients With Asthma. Methods: Adopting a societal perspective, direct medical costs and productivity loss were assessed using the Questionnaire for Health-Related Resource Use-Lung, a modification of the FIM in an Elderly Population. The effect side was operationalized as minimal important differences (MIDs) of the Asthma Control Test (ACT) and the Asthma Quality of Life Questionnaire (AQLQ) and through quality-adjusted life-years (QALYs) gained. Adjusted mean differences in costs (gamma-distributed model) and each effect parameter (Gaussian-distributed model) were simultaneously calculated within 1000 bootstrap replications to determine incremental cost-effectiveness ratios (ICERs) and to subsequently delineate cost-effectiveness acceptability curves. Results: PR caused mean costs per capita of euro 3544. Three months after PR, we observed higher mean costs (D euro 3673;95% confidence interval (CI) euro 2854- euro 4783) and improved mean effects (ACT D1.59 MIDs, 95% CI 1.37-1.81;AQLQD1.76 MIDs, 95% CI 1.46-2.08;QALYs gained D0.01, 95% CI 0.01-0.02) in the intervention group. The ICER was euro 2278 (95% CI euro 1653- euro 3181) per ACT-MID, euro 1983 (95% CI euro 1430- euro 2830) per AQLQ-MID, and euro 312401 (95% CI euro 209 206- euro 504 562) per QALY gained. Conclusions: Contrasting of PR expenditures with ICERs suggests that the intervention, which achieves clinically relevant changes in asthma-relevant parameters, has a high probability to be already cost-effective in the short term. However, in terms of QALYs, extended follow-up periods are likely required to comprehensively judge the added value of a one-time initial investment in PR.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1098-3015
• Sprache: Englisch