Cost-effectiveness of integrated disease management for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease in a primary care setting

Andrew D Scarffe; Christopher J Licskai; Madonna Ferrone; Kevin Brand; Kednapa Thavorn; Doug Coyle

doi:10.1186/s12962-022-00377-w

Cost-effectiveness of integrated disease management for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease in a primary care setting

Cost Eff Resour Alloc. 2022 Aug 12;20(1):39. doi: 10.1186/s12962-022-00377-w.

Authors

Andrew D Scarffe¹, Christopher J Licskai^{2

3

4}, Madonna Ferrone^{4

5}, Kevin Brand⁶, Kednapa Thavorn^{7

8}, Doug Coyle^{8

9}

Affiliations

¹ Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada. ascar083@uottawa.ca.
² London Health Sciences Centre, Western University, London, ON, Canada.
³ Lawson Health Research Institute, London, ON, Canada.
⁴ Asthma Research Group Windsor Essex County Inc., ON, Windsor, Canada.
⁵ Hotel-Dieu Grace Healthcare, Windsor, ON, Canada.
⁶ Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada.
⁷ Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
⁸ Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁹ Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK.

Abstract

Background: We evaluate the cost-effectiveness of the 'Best Care' integrated disease management (IDM) program for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease (COPD) compared to usual care (UC) within a primary care setting from the perspective of a publicly funded health system (i.e., Ontario, Canada).

Methods: We conducted a model-based, cost-utility analysis using a Markov model with expected values of costs and outcomes derived from a Monte-Carlo Simulation with 5000 replications. The target population included patients started in GOLD II with a starting age of 68 years in the trial-based analysis. Key input parameters were based on a randomized control trial of 143 patients (i.e., UC (n = 73) versus IDM program (n = 70)). Results were shown as incremental cost per quality-adjusted life year (QALY) gained.

Results: The IDM program for high risk, exacerbation prone, patients is dominant in comparison with the UC group. After one year, the IDM program demonstrated cost savings and improved QALYs (i.e., UC was dominated by IDM) with a positive net-benefit of $5360 (95% CI: ($5175, $5546) based on a willingness to pay of $50,000 (CAN) per QALY.

Conclusions: This study demonstrates that the IDM intervention for patients with COPD in a primary care setting is cost-effective in comparison to the standard of care. By demonstrating the cost-effectiveness of IDM, we confirm that investment in the delivery of evidence based best practices in primary care delivers better patient outcomes at a lower cost than UC.

Keywords: COPD; Chronic obstructive pulmonary disease; Cost-effectiveness; Cost-utility; Integrated disease management; Primary care.