Monninkhof E, van der Valk P, Schermer T, van der Palen J, van Herwaarden C, Zielhuis G
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
Chron Respir Dis. 2004;1(1):7-16. doi: 10.1191/1479972304cd005oa.
The main objective of this study was to investigate whether a comprehensive self-management programme, including self-treatment guidelines for exacerbations and a fitness programme, is an efficient treatment option for chronic obstructive pulmonary disease (COPD) patients.
We randomly allocated 248 COPD patients to either self-management (127) or usual care (121). Data on preference-based utilities (EuroQol-5D), health-related quality of life (HRQoL), health-care resource use and productivity losses associated with exacerbations were prospectively collected. Quality-adjusted life years (QALYs) were calculated. The economic analysis took the societal perspective and the observation period was one year.
As we observed that the groups were equally effective in terms of QALYs and HRQoL (SGRQ), we described a cost minimization analysis only. The self-management programme-specific costs amounted to Euro 642 per patient. In the base-case cost analysis, the incremental cost difference amounted to Euro 838 per patient per year in favour of usual care. When only direct medical costs were included, the incremental annual cost of self-management relative to usual care was Euro 179 per person per year. If time costs for the fitness programme were set to zero, the costs for self-management diminished to Euro 542. Sensitivity analysis showed that these results were robust to changes in the underlying assumptions.
We conclude that the COPE self-management programme is not an efficient treatment option for moderate to severe COPD patients who rate their HRQoL relatively high. The programme was twice as expensive as usual care and had no measurable beneficial effects on QALYs or HRQoL.
本研究的主要目的是调查一项综合自我管理计划，包括加重期的自我治疗指南和一项健身计划，是否是慢性阻塞性肺疾病（COPD）患者的有效治疗选择。
我们将248例COPD患者随机分为自我管理组（127例）或常规治疗组（121例）。前瞻性收集基于偏好的效用（欧洲五维健康量表）、健康相关生活质量（HRQoL）、医疗资源使用以及与加重期相关的生产力损失的数据。计算质量调整生命年（QALYs）。经济分析采用社会视角，观察期为一年。
由于我们观察到两组在QALYs和HRQoL（圣乔治呼吸问卷）方面同样有效，因此仅描述了成本最小化分析。自我管理计划的特定成本为每位患者642欧元。在基础病例成本分析中，增量成本差异为每位患者每年838欧元，有利于常规治疗。仅纳入直接医疗成本时，自我管理相对于常规治疗的年度增量成本为每人每年179欧元。如果健身计划的时间成本设为零，自我管理的成本降至542欧元。敏感性分析表明，这些结果对基础假设的变化具有稳健性。
我们得出结论，对于HRQoL评分相对较高的中重度COPD患者，COPE自我管理计划不是一种有效的治疗选择。该计划的成本是常规治疗的两倍，并且对QALYs或HRQoL没有可测量的有益影响。
