Our research on the value of improved management for COPD is published in the International Journal of COPD. In this study, we used established modelling techniques to estimate the potential health and economic benefit of theoretical policy scenarios for two interventions aimed at reducing hospitalisations due to severe exacerbation: 1) early follow-up review post-discharge from severe exacerbation hospitalisation and 2) an integrated disease management programme that provides guideline adherent care.
The results suggest increasing uptake of these two interventions represents a significant opportunity to realise health gains and, depending on the intervention and current care costs in each country, potentially generate cost savings for populations of prevalent, on-treatment COPD patients.
This research provides evidence on the theoretical impact of policies designed to improve COPD care and highlights priority areas for future research to support evidence-based policy decisions.
COPD is a progressive respiratory condition characterised by persistent airway constriction, leading to symptoms like breathlessness, chronic cough, and mucus production. It is a leading cause of death worldwide, responsible for 3.23 million deaths in 2019. The economic burden of COPD is also considerable, with the cost of illness predicted to exceed $4 trillion US dollars by 2030. Largely caused by severe exacerbations, hospitalisations are a primary driver of healthcare costs.
Effective symptom management and slower disease progression can be achieved through pharmacological and non-pharmacological intervention, and there are international quality standards for diagnosis and management best practices. However, opportunities remain to improve patient outcomes, especially in reducing avoidable hospitalisations.
We assessed theoretical policy scenarios for two interventions that reduce the risk of severe exacerbation hospitalisations: 1) an increase from the current range of 31–38% to 50% in attendance of early follow-up review appointments after severe exacerbation hospitalisation and 2) an increase from the current range of 5– 10% to 30% in the proportion of patients with access to care as part of an integrated disease management (IDM) programme.
We developed a Markov model to simulate the natural disease history for COPD and estimated hospitalisations, life years, and costs under the policy scenarios and usual care for prevalent COPD populations in England, Germany, Canada, and Japan. The intervention effects were based on evidence from retrospective population studies and clinical trials. Usual care inputs were based on published evidence for current care in each country wherever possible. Due to unknowns and uncertainty regarding the impact of the policies and the effect of the interventions respectively, we assessed a wide range of intervention uptake and effect sizes in scenario analyses.
The results suggest increasing uptake of these interventions represents a significant opportunity to realise health gains and potentially generate cost savings in populations of prevalent, on-treatment COPD patients. Improved survival was predicted for both policy scenarios. However, more additional life years were estimated for the IDM policy suggesting a greater potential for impact. The early follow-up review scenario was cost-saving in all settings, while the IDM scenario was only cost-saving in Canada and Japan at certain intervention effect sizes. The finding of variation in the cost impact coupled with the lack of evidence for key parameters highlights the need for further study to verify these findings.
Preventing severe exacerbations is key to improving patient outcomes in COPD, while reductions in related hospitalisations will support healthcare system resilience and sustainability. This study provides evidence that suggests improved adherence to guideline-recommended care can reduce hospitalisations, positively impact patient outcomes, and may generate cost savings while highlighting priority areas for further research to support evidence-based policy decisions.
The full paper is now available for open access on the International Journal of COPD website.
Adams EJ, Doornewaard A van, Ma Y, Ahmed N, Cheng MK, Watz H, et al. Estimating the Health and Economic Impact of Improved Management in Prevalent Chronic Obstructive Pulmonary Disease Populations in England, Germany, Canada, and Japan: A Modelling Study. COPD. 2023 Sep 27; doi: 10.2147/COPD.S416988.
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