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Cost-effectiveness of integrated COPD care: the RECODE cluster randomised trial
Melinde R S Boland1, Annemarije L Kruis2, Apostolos Tsiachristas3
1Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
BMJ Open
|November 4, 2015
Summary
The RECODE disease management program for chronic obstructive pulmonary disease (COPD) in primary care was not cost-effective. It resulted in higher healthcare costs and similar health outcomes, including fewer quality-adjusted life years (QALYs).
Area of Science:
- Health Services Research
- Pulmonology
- Health Economics
Background:
- Chronic obstructive pulmonary disease (COPD) management requires effective and cost-efficient strategies.
- Integrated care models aim to improve patient outcomes and resource utilization in primary care settings.
- The RECODE program was developed to enhance COPD disease management within the Dutch primary care system.
Purpose of the Study:
- To evaluate the cost-effectiveness of the RECODE COPD disease management program compared to usual care.
- To assess the impact of the RECODE program on health outcomes and healthcare costs from both healthcare and societal perspectives.
Main Methods:
- A 2-year cluster-randomised controlled trial involving 1086 patients with COPD across 40 general practices in the Netherlands.
- The intervention group received care from a multidisciplinary team trained in motivational interviewing, care planning, and exacerbation management, supported by an ICT program.
- Health outcomes (QALYs, COPD Questionnaire, St. George's Respiratory Questionnaire, exacerbations) and costs were measured.
Main Results:
- The RECODE intervention incurred additional costs of €324 per patient.
- Healthcare costs were €584 higher and societal costs were €645 higher in the intervention group compared to usual care.
- Health outcomes were comparable between groups, with a slight, statistically significant decrease of 0.04 QALYs in the intervention group.
Conclusions:
- The RECODE integrated care program for COPD in primary care was not found to be cost-effective.
- Professionally directed interventions within this program did not yield sufficient benefits to justify the increased costs.
- Further research may be needed to identify cost-effective COPD management strategies in primary care.
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