CHRONIC OBSTRUCTIVE PULMONARY DISEASE

(Cost)-effectiveness of self-treatment of exacerbations on the severity of exacerbations in patients with COPD: the COPE II study

T Effing^1,2, H Kerstjens³, P van der Valk¹, G Zielhuis⁴, J van der Palen^1,5

¹ Medisch Spectrum Twente, Department of Pulmonology, Enschede, The Netherlands
² Repatriation General Hospital, Department of Respiratory Medicine, Daw Park, South Australia, Australia
³ University Medical Center Groningen and University of Groningen, Department of Pulmonology, Groningen, The Netherlands
⁴ Radboud University Nijmegen, Department of Epidemiology, Biostatistics, and HTA, Nijmegen, The Netherlands
⁵ Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands

^{Correspondence to} Dr T Effing, Repatriation General Hospital, Department of Respiratory Medicine, Daws Road, Daw Park, SA 5041, Australia; tanja.effing{at}health.sa.gov.au

Background: Chronic obstructive pulmonary disease (COPD) is a chronic disease with a high prevalence and rapidly increasing incidence rates. The effect of self-treatment of COPD exacerbations on the severity of exacerbations during a 1-year period was examined and a cost-effectiveness analysis was performed.

Methods: Patients were randomly allocated to four 2-hour self-management sessions, with or without training in self-treatment of exacerbations. Patients in the self-treatment group received an action plan with the possibility to initiate a course of prednisolone (with or without antibiotics). During follow-up, all participants kept a daily symptom diary. These provided the data to calculate the frequency of exacerbations, the number of exacerbation days and mean daily severity scores.

Results: Data were analysed for 142 randomised patients (self-treatment: n = 70; control: n = 72). The frequency of exacerbations was identical in both study groups (mean (SD) 3.5 (2.7)). Patients in the self-treatment group reported fewer exacerbation days (median 31 (interquartile range (IQR) 8.9–67.5) in the self-treatment group vs 40 (IQR 13.3–88.2) in the control group; p = 0.064); the difference was significant in the group of patients with a high number of exacerbation days per year (>137 (90th percentile of the whole study population); p = 0.028). The mean severity score of an exacerbation day was equal in both groups. No between-group differences were found in health-related quality of life. Cost-effectiveness analyses showed that applying self-treatment saved 154 per patient, with a trend towards a lower probability for hospital admissions (0.20/patient/year in the self-treatment group vs 0.33/patient/year in the control group; p = 0.388) and a significant reduction of health care contacts (5.37/patient/year in the self-treatment group vs 6.51/patient/year in the control group; p = 0.043).

Conclusion: Self-treatment of exacerbations incorporated in a self-management programme leads to fewer exacerbation days and lower costs.

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