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Abstract
BACKGROUND: Long-term oxygen therapy in COPD is usually supervised through home-care respiratory programs. Such programs often involve an intensive education intervention at the initiation of long-term oxygen therapy, followed by an extended follow-up period that aims toward home oxygen adherence. The objective of this study was to estimate the cost-effectiveness ratio of such a maintenance program.
METHODS: A simulation model was developed that compared 2 strategies after the intensive education intervention: (1) enrollment and (2) no enrollment in a maintenance program. The study population consisted of a hypothetical cohort of 200 patients (100 patients per group; mean age, 74 years; 45% men; mean FEV1 of 43% predicted value; and mean resting PaO2 while breathing air, 50 mm Hg). Effectiveness assumptions of the program were derived from a current literature review. The primary outcome was the ratio of the incremental cost of the program per quality-adjusted life-years gained. Only direct costs were considered; a health-care system perspective was adopted. Costs are reported in 2020 Canadian dollars (Can $).
RESULTS: Over a 5-year period, an extended home-visit program may prevent 9 deaths and provide an additional 39 years of life and 24 quality-adjusted life-years. Compared with usual care (ie, no enrollment in the maintenance program), the incremental cost-effectiveness ratio was Can $17,197 per quality-adjusted life-years gained. Sensitivity analyses demonstrated the robustness of the model. Only a reduction in adherence of 25% per year would increase the incremental cost-effectiveness ratio per quality-adjusted life-years beyond the threshold of Can $50,000 that is usually considered as acceptable from a health-care system perspective.
CONCLUSIONS: An extended home-visit program to maintain or improve adherence to long-term oxygen therapy in patients with COPD would most likely be cost-effective.
- long-term oxygen therapy
- home oxygen therapy
- COPD
- adherence
- cost
- cost-effectiveness analysis
- cost-utility analysis
- health economics
Footnotes
- Correspondence: Yves Lacasse MD, Centre de Pneumologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval, 2725, Chemin Sainte-Foy, Québec, G1V 4G5, Canada. E-mail: Yves.Lacasse{at}med.ulaval.ca
See the Related Editorial on Page 1211
Financial support was provided by Groupe de Recherche en Santé Respiratoire de l’Université Laval.
The authors have disclosed no conflicts of interest.
- Copyright © 2022 by Daedalus Enterprises
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