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Gillespie, P,O'Shea, E,Casey, D,Murphy, K,Devane, D,Cooney, A,Mee, L,Kirwan, C,McCarthy, B,Newell, J,PRINCE Study Team
BMJ Open
The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial
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Objective To assess the cost-effectiveness of a structured education pulmonary rehabilitation programme (SEPRP) for chronic obstructive pulmonary disease (COPD) relative to usual practice in primary care. The programme consisted of group-based sessions delivered jointly by practice nurses and physiotherapists over 8weeks.Design Cost-effectiveness and cost-utility analysis alongside a cluster randomised controlled trial.Setting 32 general practices in Ireland.Participants 350 adults with COPD, 69% of whom were moderately affected.Interventions Intervention arm (n=178) received a 2h group-based SEPRP session per week over 8weeks delivered jointly by a practice nurse and physiotherapist at the practice surgery or nearby venue. The control arm (n=172) received the usual practice in primary care.Main outcome measures Incremental costs, Chronic Respiratory Questionnaire (CRQ) scores, quality-adjusted life years (QALYs) gained estimated using the generic EQ5D instrument, and expected cost-effectiveness at 22weeks trial follow-up.Results The intervention was associated with an increase of Euro944 (95% CIs 489 to 1400) in mean healthcare cost and Euro261 (95% CIs 226 to 296) in mean patient cost. The intervention was associated with a mean improvement of 1.11 (95% CIs 0.35 to 1.87) in CRQ Total score and 0.002 (95% CIs -0.006 to 0.011) in QALYs gained. These translated into incremental cost-effectiveness ratios of Euro850 per unit increase in CRQ Total score and Euro472000 per additional QALY gained. The probability of the intervention being cost-effective at respective threshold values of Euro5000, Euro15000, Euro25000, Euro35000 and Euro45000 was 0.980, 0.992, 0.994, 0.994 and 0.994 in the CRQ Total score analysis compared to 0.000, 0.001, 0.001, 0.003 and 0.007 in the QALYs gained analysis.Conclusions While analysis suggests that SEPRP was cost-effective if society is willing to pay at least Euro850 per one-point increase in disease-specific CRQ, no evidence exists when effectiveness was measured in QALYS gained.Trial Registration Current Controlled Trials ISRCTN52403063.
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