Economic benefits of self-management education in COPD.

Abstract

CONTEXT: There is emerging evidence that disease management with self-management education provided by a case manager might benefit COPD patients. OBJECTIVE: To determine whether disease management with self-management education is more cost-effective than usual care among previously hospitalized COPD patients. DESIGN: Economic analysis in conjunction with a multicenter randomized clinical trial comparing patients conducting self-management with those receiving usual care over a 1-year follow-up period. SETTING: Respiratory referral centers. PATIENTS: One hundred ninety-one COPD patients who required hospitalization in the year preceding enrollment were recruited from seven respiratory outpatient clinics. INTERVENTION: In addition to usual care, patients in the intervention group received standardized education on COPD self-management program called "Living Well with COPD" with ongoing supervision by a case manager. MAIN OUTCOME MEASURES: From the perspective of the health-care payer, we compared costs between the two groups and estimated the program cost per hospitalization prevented (incremental cost-effectiveness ratio of the program). We repeated these estimates for several alternate scenarios of patient caseload. RESULTS: The additional cost of the self-management program as compared to usual care, $3,778 (2004 Canadian dollars) per patient, exceeded the savings of $3,338 per patient based on the study design with a caseload of 14 patients per case manager. However, through a highly plausible sensitivity analysis, it was showed that if case managers followed up 50 patients per year, the self-management intervention would be cost saving relative to usual care (cost saving of $2,149 per patient; 95% confidence interval, $38 to $4,258). With more realistic potential caseloads of 50 to 70 patients per case manager, estimated program costs would be $1,326 and $1,016 per prevented hospitalization, respectively. CONCLUSION: The program of self-management in COPD holds promise for positive economic benefits with increased patient caseload and rising costs of hospitalization.