What are the effects of pulmonary rehabilitation on healthcare costs and survival

The costs of caring for patients with COPD are extremely high in comparison with those with asthma, mostly due to the high costs of hospitalization and chronic oxygen therapy in patients with COPD. It is therefore important to look very carefully at all treatments that might reduce the number and duration of hospitalizations. Several uncontrolled trials suggest that pulmonary rehabilitation is effective in decreasing the number of hospital days and number of hospitalizations [70-72]. Hudson et al. followed up 64 patients for 4 years [70]. They showed that for the 44 patients who were alive after 4years, the total number of days of hospitalization decreased from 529 in the year prior to the study to 207 in the last year of the study. Recently, an Italian uncontrolled study also showed a significant reduction in the number of hospitalizations compared to the period before rehabilitation started [38]. However, these positive effects have not yet been confirmed in controlled studies. The most important study in this respect is by Ries et al. [43]. Patients received either an 8-week comprehensive outpatient rehabilitation programme or an 8-week

Years

Fig. 12.7 Survival in patients with chronic obstructive pulmonary disease following a rehabilitation programme (R, solid line) and control COPD patients following an education programme (E, dashed line). No significant differences were found between the two groups [40].

Years

Fig. 12.7 Survival in patients with chronic obstructive pulmonary disease following a rehabilitation programme (R, solid line) and control COPD patients following an education programme (E, dashed line). No significant differences were found between the two groups [40].

education programme. During the first year, the patients were supervised once a month. The study showed that the rehabilitation group tended to have fewer hospitalization days after rehabilitation compared to the education group, but the difference did not reach significance (P = 0.2). Also, there was no difference in the survival between the two groups (Fig. 12.7).

Recently, Griffiths et al. investigated the difference in mean costs and in quality-adjusted life years (QALYs) of 12months of care after either a 6-week outpatient multidisciplinary programme or standard medical treatment [73]. They showed that the programme resulted in an increase in the mean number of QALYs of 0.03 per patient (P = 0.03). Their conclusion was that the programme was cost-effective and even more effective in comparison with the programme used by Goldstein et al. [74], which incorporated a substantial period of in-patient care.

There have also been a few studies carrying out cost-benefit analyses of home-based rehabilitation. Campbell-Haggerty et al. [72] included 20 patients with a mean FEV1 of 700mL in a so-called 'respi-care' programme, which was coordinated by a hospital-based pulmonary nurse specialist, advised by a pulmonologist. The 'respi-care' service included nursing visits every week and respiratory therapy and social service every 2weeks. The mean time that the patients participated in the study was 19months (range 6-37 months). Each subject was matched for an equal length of time before entering the programme. The 'respi-care' programme resulted in a significant decrease in hospital days and emergency room visits and a reduction in costs of $328 per patient per month. These results were supported by the study by Roselle et al. [75], who included 418 patients with COPD in a programme consisting of home visits by a professional nurse at a minimum of once every 30 days. The patients were also visited by a respiratory therapist, as determined by the patient's needs. Compared to the period before the patients entered the programme, there was a significant decrease in the length of hospital stay (from 18.3days to 6.1 days), resulting in cost savings of $2625 per patient for 1 year. In our own study [39], we retrospectively examined the costs of a home programme and compared them with the costs of an outpatient programme. The costs of a home programme, with a local physiotherapist visiting once a week for 18months, were 50% lower compared to a once-weekly visit to the outpatient clinic ($2300 versus $4250 per patient for 18months). The difference was mainly due to the costs for the patients of travelling to the hospital for the outpatient programme.

Was this article helpful?

0 0
Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

Get My Free Ebook


Post a comment