Clinical Epidemiology and Ageing

Simulation-Based Estimates of the Effectiveness and Cost-Effectiveness of Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease in France.

Atsou K, Créquit P, Chouaid C, Hejblum G PLoS One. 2016;11(6):e0156514.

<p><b>BACKGROUND: </b>The medico-economic impact of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is poorly documented.</p><p><b>OBJECTIVE: </b>To estimate the effectiveness and cost-effectiveness of pulmonary rehabilitation in a hypothetical cohort of COPD patients.</p><p><b>METHODS: </b>We used a multi-state Markov model, adopting society's perspective. Simulated cohorts of French GOLD stage 2 to 4 COPD patients with and without pulmonary rehabilitation were compared in terms of life expectancy, quality-adjusted life years (QALY), disease-related costs, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses included variations of key model parameters.</p><p><b>PRINCIPAL FINDINGS: </b>At the horizon of a COPD patient's remaining lifetime, pulmonary rehabilitation would result in mean gain of 0.8 QALY, with an over disease-related costs of 14 102 € per patient. The ICER was 17 583 €/QALY. Sensitivity analysis showed that pulmonary rehabilitation was cost-effective in every scenario (ICER <50 000 €/QALY).</p><p><b>CONCLUSIONS: </b>These results should provide a useful basis for COPD pulmonary rehabilitation programs.</p>

MeSH terms: Computer Simulation; Cost-Benefit Analysis; Decision Trees; France; Humans; Probability; Pulmonary Disease, Chronic Obstructive; Respiration; Sensitivity and Specificity; Treatment Outcome
DOI: 10.1371/journal.pone.0156514