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19 April 2019 : Clinical Research  

Cost-Effectiveness Analysis of Integrated Care in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD)

Ewa Bandurska1ACDEF*, Iwona Damps-Konstańska2ABD, Piotr Popowski1ABD, Tadeusz Jędrzejczyk3ABD, Piotr Janowiak2ABF, Katarzyna Świętnicka4BC, Marzena Zarzeczna-Baran1EFG, Ewa Jassem2ADEG

DOI: 10.12659/MSM.913358

Med Sci Monit 2019; 25:2879-2885

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common disease that occurs all over the world. Models of care, initially accessed from the clinical point of view, must also be evaluated in terms of their economic effectiveness, as health care systems are limited. The Integrated Care Model (ICM) is a procedure dedicated to patients suffering from advanced COPD that offers home-oriented support from a multidisciplinary team. The main aim of the present study was to evaluate the cost-effectiveness of the ICM.

MATERIAL AND METHODS: We included 44 patients in the study (31 males, 13 females) with an average age 72 years (Me=71). Costs of care were estimated based on data received from public payer records and included general costs, COPD-related costs, and exacerbation-related costs. To evaluate cost-effectiveness, cost-effectiveness analysis (CEA) was used. The incremental cost-effectiveness ratio (ICER) was calculated based on changes in health care resources utilization and the value of costs observed in 2 consecutive 6-month periods before and after introducing ICM.

RESULTS: Costs of care of all types decreased after introducing ICM. Demand for ambulatory visits changed significantly (p=0.037) together with a substantial decrease in the number of emergency department appointments and hospitalizations (p=0.033). ICER was more profitable for integrated care than for standard care when assessing costs of avoiding negative parameters such as hospitalizations (–227 EUR), exacerbations-related hospitalizations (–312 EUR), or emergency procedures (–119 EUR).

CONCLUSIONS: ICM is a procedure that meets the criteria of cost-effectiveness. It allows for avoiding negative parameters such as unplanned hospitalizations with higher economic effectiveness than the standard type of care used in managing COPD.

Keywords: Delivery of Health Care, Integrated, Economics, Pharmaceutical, Pulmonary Disease, Chronic Obstructive, Aged, Cost-Benefit Analysis, Disease Progression, Health Care Costs, Hospitalization, Managed Care Programs, Middle Aged, Models, Econometric, Poland

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750