Steiner Michael, Mahon James, Fuld Jonathan, Hex Nick
Leicester NIHR Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, University of Leicester, Leicester, UK.
York Health Economics Consortium Ltd, University of York, Heslington, UK.
Chron Respir Dis. 2024 Jan-Dec;21:14799731241307248. doi: 10.1177/14799731241307248.
Increasing uptake and completion of Pulmonary Rehabilitation in people with COPD has the potential to deliver health benefit and reduce health inequalities. We have quantified the cost-effectiveness of enhancing PR access and completion by reviewing the cost-effectiveness literature for PR in COPD. A literature review identified studies that provided cost-effectiveness evidence for PR compared to no PR. The key metrics of interest were healthcare resource use and cost savings, and quality adjusted life year (QALY) gains. Healthcare resource use data were valued using the UK NHS National Tariff 2022/23. From the literature search we identified the QALY gain resulting from completion of PR. The value of the QALY gain resulting from PR completion was calculated using the standard willingness-to-pay threshold of £20,000 considered by the UK National Institute for Health and care Excellence (NICE). We estimated a QALY gain resulting from completion of PR of 0.065 and value of the QALY gain was therefore calculated to be £1300 per person completing PR. We estimated the 12 month reduction in hospitalisation following completion of PR to be 8.2% giving a total cost reduction per patient of £245. We therefore calculated that up to £1545 could be spent per person with COPD to deliver PR cost-effectively. Our analysis provides commissioners with the information they need to make informed decisions about planning and provision of PR. The data allows estimation of additional resources that could be deployed in addressing inequitable access to PR among disadvantaged and underserved populations whilst retaining cost effectiveness of the intervention.
提高慢性阻塞性肺疾病（COPD）患者对肺康复（PR）的接受度和完成率有可能带来健康益处并减少健康不平等现象。我们通过回顾COPD患者PR的成本效益文献，对增强PR可及性和完成率的成本效益进行了量化。文献综述确定了提供PR与无PR相比的成本效益证据的研究。关注的关键指标是医疗资源使用、成本节约以及质量调整生命年（QALY）增益。医疗资源使用数据采用英国国民健康服务体系（NHS）2022/23年度国家收费标准进行估值。通过文献检索，我们确定了完成PR所带来的QALY增益。PR完成所带来的QALY增益价值是使用英国国家卫生与临床优化研究所（NICE）考虑的20,000英镑的标准支付意愿阈值计算得出的。我们估计完成PR带来的QALY增益为0.065，因此计算得出每位完成PR的人的QALY增益价值为1300英镑。我们估计完成PR后12个月内住院率降低8.2%，每位患者的总成本降低245英镑。因此，我们计算得出，为每位COPD患者提供具有成本效益的PR，最高可花费1545英镑。我们的分析为决策者提供了他们在规划和提供PR时做出明智决策所需的信息。这些数据有助于估计可用于解决弱势群体和服务不足人群中PR获取不平等问题的额外资源，同时保持干预措施的成本效益。
