Clinical and cost-effectiveness of SPACE for COPD delivered as a pulmonary rehabilitation maintenance programme: a randomised controlled trial.

Abstract

The benefits of pulmonary rehabilitation (PR) decline after 6-12 months. Previous studies of maintenance in the literature have been labour-intensive and concentrated on secondary care healthcare utilisation only. We aimed to investigate whether Self-management Programme of Activity, Coping and Education (SPACE) for chronic obstructive pulmonary disease (COPD), a light-touch self-management programme, was clinically and cost-effective following PR. We conducted a prospective, multicentre, assessor-blind randomised controlled trial. Patients with COPD were randomised 1:1 to usual care (control) or SPACE. The intervention included a home-based manual and four facilitated group sessions, delivered over 12 months. Endurance Shuttle Walking Test at 12 months. maximal exercise capacity, mood, patient activation, physical activity, healthcare costs and health-related quality-of-life (HRQoL). 116 participants were recruited (October 2019-June 2022). Baseline characteristics: SPACE (65% male, aged 71.8 years, median Medical Research Council (MRC) 3, mean pack years 41.1, mean body mass index (BMI) 29.1), control (51% male, aged 71.8 years, median MRC 3, mean pack years 44.5, mean BMI 28.3). SPACE completion rate=83% and intervention fidelity (assessed via checklist) was excellent. No statistically significant differences at 12 months for primary and secondary outcomes. Economic analysis at 12 months shows a positive HRQoL difference between groups of 0.0871 quality adjusted life years (QALY) and reduced National Health Service (NHS) costs of £139 per participant, driven primarily by a reduction in general practitioner visits in favour of SPACE. Endurance exercise tolerance was maintained in both groups. The programme improved HRQoL at 12 months in the intervention group (above control) and was cost-effective, driven by reduced primary care costs.