Chest
Volume 130, Issue 6, December 2006, Pages 1704-1711
Journal home page for Chest

Original Research: COPD
Economic Benefits of Self-Management Education in COPD

https://doi.org/10.1378/chest.130.6.1704Get rights and content

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.

Section snippets

Materials and Methods

The design and methods of this trial have been described in more detail elsewhere,12 and are briefly summarized below.

Study Subjects

The clinical results of our trial have been described elsewhere.12 Of the 469 eligible COPD patients, 251 refused to participate, while 27 agreed but could not be enrolled because they lived too far away from the study sites. The main reason for patient refusal was the perceived burden of study-related evaluations, given the 50% likelihood of remaining with usual care. Potential eligible patients who did not participate were similar to the 191 study participants with respect to sex, age, and

Discussion

This study has demonstrated that a multicomponent self-management education program with ongoing supervision by a case manager can reduce the use of health services among previously hospitalized patients with moderate-to-severe COPD. This reduction is primarily the result of fewer hospitalizations, emergency department visits, and unscheduled physician visits. Although the 1-year time frame may seem short to policy makers, we have recently shown that the benefit of our program is sustained past

Appendix

Participating members of the COPD axis of the Respiratory Health Network of the Fond de la Recherche en Santé du Québec were as follows: Jean Bourbeau, MD and Diane Nault, RN, Montréal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre; Paolo Renzi, MD, Hôpital Notre-Dame, Centre hospitalier affilié de l’Université de Montréal; Marcel Julien, MD, Hôpital du Sacré-Cœur, Centre hospitalier affilié de l’Université de Montréal; Alain Beaupré, MD, Centre hospitalier

References (40)

  • NorrisSL et al.

    The effectiveness of disease and case management for people with diabetes: a systematic review

    Am J Prev Med

    (2002)
  • MurrayCJL et al.
    (1996)
  • SeemungalTA et al.

    Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (1998)
  • OsmanL et al.

    Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease

    Thorax

    (1997)
  • StrasselsS et al.

    Characterization of the incidence and cost of COPD in the US [abstract]

    Eur Respir J

    (1996)
  • SiafakasNM et al.

    Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force

    Eur Respir J

    (1995)
  • FeinleibM et al.

    Trends in COPD morbidity and mortality in the United States

    Am Rev Respir Dis

    (1989)
  • HissRG et al.

    Community diabetes care: a 10 year perspective

    Diabetes Care

    (1994)
  • RichMW et al.

    A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure

    N Engl J Med

    (1995)
  • Von KorffM et al.

    Collaborative management of chronic illness

    Ann Intern Med

    (1997)
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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    Members of the COPD axis of the Respiratory Health Network of the FRSQ who have participated in the research project are listed in the Appendix.

    This study was made possible by an unrestricted grant from Boehringer Ingelheim Canada, Burlington, ON, in partnership with the Fonds de la recherche en santé du Québec, Montréal, QC, Canada. Dr. Schwartzman is the recipient of a Chercheur-Boursier Clinicien career award from the Fonds de la Recherche en Santé du Québec.

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