School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, 130021, China.
Orthopaedics Department, China-Japan Union Hospital of Jilin University, Changchun, China.
Appl Health Econ Health Policy. 2021 May;19(3):313-324. doi: 10.1007/s40258-020-00613-5. Epub 2020 Oct 20.
Chronic obstructive pulmonary disease (COPD) has high morbidity and mortality rates. COPD impairs body functioning, reduces quality of life, and creates a great economic burden for society. Pulmonary rehabilitation (PR) has become an important nonpharmacological treatment for COPD. This paper systematically reviews economic evaluations of PR in COPD patients in different settings.
We aimed to understand the cost-effectiveness of PR in different settings for COPD to provide economic evidence for decision-makers.
We searched eight databases from their inception to 23 November 2019. The results were presented in terms of an incremental cost-effectiveness ratio (ICER), and the decision uncertainty was expressed by cost-effectiveness acceptability curves (CEACs). We used the Consensus on Health Economic Criteria to assess study quality.
This review included ten studies that matched the selection criteria. Five studies compared PR with usual care in primary healthcare or outpatient departments. Two studies compared community-based PR with hospital PR or usual care. In the other studies, PR was mainly carried out at home. Compared with usual care, PR was cost-effective in primary healthcare institutions or outpatient departments. According to CEACs, community-based PR had a 50% probability of cost-effectiveness at £30,000/quality-adjusted life year (QALY) compared with hospital PR in the UK. Based on the ICER, community-based PR was "moderately" cost-effective, with a ratio of €32,425/QALY compared with usual care in the Netherlands. Home-based PR was dominant compared with usual care, and tele-rehabilitation was dominant compared with traditional home PR.
PR conducted in different settings can potentially be cost-effective, as measured using QALY or the Chronic Respiratory Questionnaire (CRQ).
慢性阻塞性肺疾病（COPD）发病率和死亡率高。COPD 会损害身体机能，降低生活质量，并给社会带来巨大的经济负担。肺康复（PR）已成为 COPD 的一种重要非药物治疗方法。本文系统地综述了不同环境下 COPD 患者 PR 的经济评价。
了解不同环境下 PR 治疗 COPD 的成本效益，为决策者提供经济依据。
我们从建库到 2019 年 11 月 23 日在 8 个数据库中进行了检索。结果以增量成本效益比（ICER）表示，决策不确定性用成本效益接受曲线（CEACs）表示。我们使用健康经济标准共识来评估研究质量。
本综述纳入了 10 项符合选择标准的研究。5 项研究比较了初级保健机构或门诊部门中 PR 与常规护理的效果。2 项研究比较了社区为基础的 PR 与医院 PR 或常规护理的效果。在其他研究中，PR 主要在家中进行。与常规护理相比，PR 在初级保健机构或门诊部门具有成本效益。根据 CEACs，在英国，与医院 PR 相比，社区为基础的 PR 在 30000 英镑/QALY 时具有 50%的成本效益概率。根据 ICER，与荷兰的常规护理相比，社区为基础的 PR 具有“适度”的成本效益，比值为 32425 欧元/QALY。与常规护理相比，家庭为基础的 PR 具有优势，远程康复与传统家庭 PR 相比具有优势。
用 QALY 或慢性呼吸系统问卷（CRQ）衡量，不同环境下开展的 PR 具有潜在的成本效益。
