Pulmonary rehab after COPD hospitalization results in net cost savings

Pulmonary rehabilitation after hospitalization for COPD resulted in net cost savings and improvement in quality-adjusted life expectancy, according to an economic evaluation published in JAMA Network Open.

“Despite consistent evidence of benefits in both randomized clinical trials and large observational studies, uptake of pulmonary rehabilitation remains low,” Christopher L. Mosher, MD, MHS, critical care specialist in the division of pulmonary, allergy and critical care medicine at Duke University Medical Center and Duke Clinical Research Institute in Durham, North Carolina, and colleagues wrote. “Lack of access to transport and copayments have been cited as major hurdles to uptake and adherence, whereas others have pointed to poor reimbursement as the critical barrier to broader use.”

Researchers performed an economic evaluation to estimate the cost-effectiveness of pulmonary rehabilitation participantion compared with no pulmonary rehab after hospitalization for COPD in the U.S. Researchers estimated the cost-effectiveness in the U.S. health care system with a lifetime horizon, 1-year cycle length and a discounted 3% rate per year for costs and outcomes, according to the study. The researchers analyzed published literature from October 2001 to April 2021, including an analysis of Medicare beneficiaries with COPD that was conducted from 2019 to 2021. The hypothetical cohort had a mean age of 76.9 years and 58.6% were women.
The primary outcomes were net cost in U.S. dollars, quality-adjusted life-years and incremental cost-effectiveness.

From a societal perspective, the base case microsimulation demonstrated a net cost savings of $5,721 per patient and an improved quality-adjusted life expectancy of 0.53 years after pulmonary rehabilitation.

Among all 1,000 samples, pulmonary rehabilitation resulted in net cost savings and improved quality-adjusted life expectancy in a probabilistic sensitivity analysis. In addition, pulmonary rehabilitation was the dominant strategy in 100% of simulations at any willingness-to-pay threshold, the researchers reported.

Researchers observed no change in the net cost savings and improved quality-adjusted life expectancy in univariate analyses based on patient age, the Global Initiative for Obstructive Lung Disease stage or number of pulmonary rehabilitation sessions.

A single pulmonary rehabilitation session resulted in a cost savings of $171 per session with an incremental cost-effectiveness ratio of $884 per session for $50,000 per QALY and $1,597 per session for $100,000 per QALY in a one-way sensitivity analysis of total cost when assuming 36 completed pulmonary rehabilitation sessions.

“Given these findings, payers — particularly Medicare — should identify policies that would increase access and adherence to pulmonary rehabilitation programs for patients living with COPD,” the researchers wrote.