Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme
- aSection of Respiratory Medicine, Department of Medicine, University of Wales College of Medicine, Llandough Hospital, Penarth, Vale of Glamorgan CF64 2XX, UK, bSchool of Health Science, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK, cDepartment of Public Health Medicine, University of Wales College of Medicine, Temple of Peace and Health, Cathays Park, Cardiff CF1 3NW, UK, dDirectorate of Medicine, Cardiff and Vale NHS Trust, Llandough Hospital, Penarth, Vale of Glamorgan CF64 2XX, UK
- Dr T L Griffiths
- Received 6 October 2000
- Revision requested 7 March 2001
- Revised 9 May 2001
- Accepted 15 June 2001
BACKGROUND Pulmonary rehabilitation programmes improve the health of patients disabled by lung disease but their cost effectiveness is unproved. We undertook a cost/utility analysis in conjunction with a randomised controlled clinical trial of pulmonary rehabilitation versus standard care.
METHODS Two hundred patients, mainly with chronic obstructive pulmonary disease, were randomly assigned to either an 18 visit, 6 week rehabilitation programme or standard medical management. The difference between the mean cost of 12 months of care for patients in the rehabilitation and control groups (incremental cost) and the difference between the two groups in quality adjusted life years (QALYs) gained (incremental utility) were determined. The ratio between incremental cost and utility (incremental cost/utility ratio) was calculated.
RESULTS Each rehabilitation programme for up to 20 patients cost £12 120. The mean incremental cost of adding rehabilitation to standard care was £ –152 (95% CI –881 to 577) per patient, p=NS. The incremental utility of adding rehabilitation was 0.030 (95% CI 0.002 to 0.058) QALYs per patient, p=0.03. The point estimate of the incremental cost/utility ratio was therefore negative. The bootstrapping technique was used to model the distribution of cost/utility estimates possible from the data. A high likelihood of generating QALYs at negative or relatively low cost was indicated. The probability of the cost per QALY generated being below £0 was 0.64.
CONCLUSIONS This outpatient pulmonary rehabilitation programme produces cost per QALY ratios within bounds considered to be cost effective and is likely to result in financial benefits to the health service.
This study was funded by a project grant from the Wales Office of Research and Development for Health and Social Care.