Cost-Effectiveness of Pulmonary Rehabilitation in Patients With Bronchial Asthma: An Analysis of the EPRA Randomized Controlled Trial

Denise Böckmann; Boglárka Lilla Szentes; Konrad Schultz; Dirk Nowak; Michael Schuler; Larissa Schwarzkopf

doi:10.1016/j.jval.2021.01.017

Cost-Effectiveness of Pulmonary Rehabilitation in Patients With Bronchial Asthma: An Analysis of the EPRA Randomized Controlled Trial

Value Health. 2021 Sep;24(9):1254-1262. doi: 10.1016/j.jval.2021.01.017. Epub 2021 Apr 30.

Authors

Denise Böckmann¹, Boglárka Lilla Szentes², Konrad Schultz³, Dirk Nowak⁴, Michael Schuler⁵, Larissa Schwarzkopf⁶

Affiliations

¹ Institute for Medical Information Processing, Biometry and Epidemiology - IBE, LMU Munich, Munich, Germany; Pettenkofer School of Public Health, Munich, Germany; Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research (DZL), Neuherberg, Germany. Electronic address: denise.boeckmann7@gmail.com.
² Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research (DZL), Neuherberg, Germany.
³ Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany.
⁴ LMU University of München, Institute and Clinic for Occupational, Social and Environmental Medicine, member DZL, German Centre for Lung Research, München, Germany.
⁵ Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
⁶ Pettenkofer School of Public Health, Munich, Germany; Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research (DZL), Neuherberg, Germany; IFT-Institut für Therapieforschung, Munich, Germany.

PMID: 34452704
DOI: 10.1016/j.jval.2021.01.017

Abstract

Objectives: At 3 months after the intervention, this study evaluates the cost-effectiveness of a 3-week inpatient pulmonary rehabilitation (PR) in patients with asthma compared with usual care alongside the single-center randomized controlled trial-Effectiveness of Pulmonary Rehabilitation in Patients With Asthma.

Methods: Adopting a societal perspective, direct medical costs and productivity loss were assessed using the Questionnaire for Health-Related Resource Use-Lung, a modification of the FIM in an Elderly Population. The effect side was operationalized as minimal important differences (MIDs) of the Asthma Control Test (ACT) and the Asthma Quality of Life Questionnaire (AQLQ) and through quality-adjusted life-years (QALYs) gained. Adjusted mean differences in costs (gamma-distributed model) and each effect parameter (Gaussian-distributed model) were simultaneously calculated within 1000 bootstrap replications to determine incremental cost-effectiveness ratios (ICERs) and to subsequently delineate cost-effectiveness acceptability curves.

Results: PR caused mean costs per capita of €3544. Three months after PR, we observed higher mean costs (Δ€3673; 95% confidence interval (CI) €2854-€4783) and improved mean effects (ACT Δ1.59 MIDs, 95% CI 1.37-1.81; AQLQ Δ1.76 MIDs, 95% CI 1.46-2.08; QALYs gained Δ0.01, 95% CI 0.01-0.02) in the intervention group. The ICER was €2278 (95% CI €1653-€3181) per ACT-MID, €1983 (95% CI €1430-€2830) per AQLQ-MID, and €312 401 (95% CI €209 206-€504 562) per QALY gained.

Conclusions: Contrasting of PR expenditures with ICERs suggests that the intervention, which achieves clinically relevant changes in asthma-relevant parameters, has a high probability to be already cost-effective in the short term. However, in terms of QALYs, extended follow-up periods are likely required to comprehensively judge the added value of a one-time initial investment in PR.

Keywords: asthma; asthma control; health economic evaluation; health-related quality of life; inpatient rehabilitation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Asthma / rehabilitation*
Cost-Benefit Analysis*
Female
Health Care Surveys
Humans
Male
Middle Aged
Quality of Life
Randomized Controlled Trials as Topic*
Rehabilitation / economics*