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Economic Evaluation of Community-Based Case Management of Patients Suffering From Chronic Obstructive Pulmonary Disease

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Abstract

Objectives

To analyse the cost effectiveness of community-based case management for patients suffering from chronic obstructive pulmonary disease (COPD).

Methods

The study took place in the third largest municipality in Denmark and was conducted as a randomised controlled trial with 12 months of follow-up. A total of 150 patients with COPD were randomised into two groups receiving usual care and case management in addition to usual care. Case management included among other things self care proficiency, medicine compliance, and care coordination. Outcome measure for the analysis was the incremental cost-effectiveness ratio (ICER) as cost per quality-adjusted life year (QALY) from the perspective of the healthcare sector. Costs were valued in British Pounds (£) at price level 2016. Scenario analyses and probabilistic sensitivity analyses were conducted in order to assess uncertainty of the ICER estimate.

Results

The intervention resulted in a QALY improvement of 0.0146 (95% CI −0.0216; 0.0585), and a cost increase of £494 (95% CI −1778; 2766) per patient. No statistically significant difference was observed either in costs or effects. The ICER was £33,865 per QALY gained. Scenario analyses confirmed the robustness of the result and revealed slightly lower ICERs of £28,100–£31,340 per QALY.

Conclusions

Analysis revealed that case management led to a positive incremental QALY, but were more costly than usual care. The highly uncertain ICER somewhat exceeds for instance the threshold value used by the National Institute of Health and Care Excellence (NICE). No formally established Danish threshold value exists.

ClinicalTrials.gov Identifier: NCT01512836.

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Acknowledgements

The authors would like to thank Thomas Mulvad from The North Denmark Region, Denmark, and Tommi Vorbeck Nielsen from Aalborg Municipality, Denmark, for their cooperation in extraction of register data used in the study.

Author contributions

SSS conceived the study design; acquired the data; performed the analyses and interpretation of data; and drafted the manuscript for publication. KMP, UMW and LE contributed to the study design and interpretation of the results, and reviewed and recommended revisions to the submitted manuscript to ensure accuracy. All authors have read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University, Fibigerstræde 11, 9220, Aalborg, Denmark

    Sabrina Storgaard Sørensen, Kjeld Møller Pedersen & Lars Ehlers

  2. University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark

    Kjeld Møller Pedersen

  3. Department of Respiratory Diseases, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Ulla Møller Weinreich

  4. The Clinical Institute, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Ulla Møller Weinreich

Authors
  1. Sabrina Storgaard Sørensen
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  4. Lars Ehlers
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Corresponding author

Correspondence to Sabrina Storgaard Sørensen.

Ethics declarations

Ethical approval

All procedures performed in the RCT were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors Sabrina Storgaard Sørensen, Kjeld Møller Pedersen, Ulla Møller Weinreich and Lars Ehlers declare that they have no conflict of interest.

Funding

The research project received support from The North Denmark Region, Denmark. The sponsors of the study had no role in data analysis, data interpretation, or writing of the paper.

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Sørensen, S.S., Pedersen, K.M., Weinreich, U.M. et al. Economic Evaluation of Community-Based Case Management of Patients Suffering From Chronic Obstructive Pulmonary Disease. Appl Health Econ Health Policy 15, 413–424 (2017). https://doi.org/10.1007/s40258-016-0298-2

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