Cost-utility analysis of a Home-based disease management intervention for patients with severe COPD in the COMET study.

Abstract

Background: Economic evaluation of non-pharmacological interventions in severe COPD patients is scarce. The COPD patient Management European randomised controlled Trial (COMET) compared a Disease Management (DM) intervention versus Usual Management (UM) in Europe. DM included home telemonitoring, self-management, care coordination, and medical management. Objective: To perform a health-economic evaluation of DM intervention versus UM in the COMET study from a national payer perspective. Methods: The methodology was based on a fully pooled analysis with multi-country costing. Country-specific medical resource use collected and published tariffs were used to evaluate direct medical costs. Quality of life data were collected using the 15D health-related quality of life instrument. Effectiveness difference expressed in Quality-Adjusted Life Years (QALY) was reported to cost difference between DM and UM. Probabilistic Sensitivity Analysis was performed in order to assess the probability of being cost-effective (below 20,000€/QALY acceptability threshold). Results: DM brought additional QALYs (+0.099QALY) and cost-savings versus UM (-37.50€/patient/year) leading to a dominant position. Even if 95% confidence interval of the cost-savings was [−2,808€ ; 2,545€], the probability of DM being cost-effective versus UM was 91%. Conclusion: This cost-utility analysis based on the COMET study suggests that the management of severe COPD patients using home-based DM is an interesting economic option for national payers.