Identifying potentially cost effective chronic care programs for people with COPD
January 2009
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Objective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified. Methods: Systematic search of Medline and Cochrane databases for evaluations of multicomponent disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized. Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money. Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of 'perfect data', support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision uncertainty.
- human
- clinical trial
- Cost-effectiveness
- outcome assessment
- MEDLINE
- medical decision making
- health economics
- review
- quality of life
- hospitalization
- COPD
- chronic obstructive lung disease
- evidence based medicine
- systematic review
- health care cost
- health care quality
- health care utilization
- patient education
- Review
- Cochrane Library
- health program
- health care delivery
- long term care
- survival rate
- cost effectiveness analysis
- antibiotic agent
- hospital cost
- Chronic care management
- bronchodilating agent
- oxygen therapy
- social support
- steroid
- program
- study
- patient
- health
- disease
- management
- intervention
- outcome
- component
- hospital
- visit
- quality
- review
- care programs
- signi
- effectiveness
- system
- disease management
- follow-up
- copd care programs
