Background

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.

Objectives

We aimed to understand the cost-effectiveness of PR in different settings for COPD to provide economic evidence for decision-makers.

Methods

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.

Results

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.

Conclusions

PR conducted in different settings can potentially be cost-effective, as measured using QALY or the Chronic Respiratory Questionnaire (CRQ).

中文翻译：

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不同环境下慢阻肺肺康复的成本效益：系统评价

背景

慢性阻塞性肺疾病 (COPD) 的发病率和死亡率都很高。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 的重要非药物治疗方法。本文系统地回顾了不同环境下 COPD 患者 PR 的经济评估。

目标

我们旨在了解 PR 在 COPD 不同情况下的成本效益，为决策者提供经济证据。

方法

我们检索了从开始到 2019 年 11 月 23 日的八个数据库。结果以增量成本效益比 (ICER) 表示，决策不确定性以成本效益可接受性曲线 (CEAC) 表示。我们使用卫生经济标准共识来评估研究质量。

结果

该评价包括符合选择标准的十项研究。五项研究将 PR 与初级保健或门诊部门的常规护理进行了比较。两项研究将基于社区的 PR 与医院 PR 或常规护理进行了比较。在其他研究中，PR主要在家里进行。与普通护理相比，PR在基层医疗机构或门诊部门具有成本效益。根据 CEAC，与英国医院 PR 相比，基于社区的 PR 在 30,000 英镑/质量调整生命年 (QALY) 的成本效益概率为 50%。根据 ICER，基于社区的 PR 具有“中等”成本效益，与荷兰的常规护理相比，其比率为 32,425 欧元/QALY。与常规护理相比，以家庭为基础的 PR 占主导地位，与传统的家庭 PR 相比，远程康复占主导地位。

结论

使用 QALY 或慢性呼吸问卷 (CRQ) 衡量，在不同环境中进行的 PR 可能具有成本效益。