Research article

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

Melinde RS Boland, Apostolos Tsiachristas, Annemarije L Kruis, Niels H Chavannes and Maureen PMH Rutten-van Mölken

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BMC Pulmonary Medicine 2013, 13:40 doi:10.1186/1471-2466-13-40

Published: 3 July 2013

Abstract (provisional)

Background

There 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.

Methods

We 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.

Results

Sixteen 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 [euro sign]1060 (95% CI: [euro sign]2040 to [euro sign]80) per patient per year and savings in total healthcare utilization of [euro sign]898 (95% CI: [euro sign]1566 to [euro sign]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.

Conclusions

COPD-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.

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