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Economic Benefits of Self-Management Education in COPD^*

Jean Bourbeau, MD, MSc; Jean-Paul Collet, MD, PhD; Kevin Schwartzman, MD, MPH; Thierry Ducruet, MSc; Diane Nault, RN, MSc; Carole Bradley, MSc; the COPD axis of the Respiratory Health Network of the Fond de la recherche en santé du Québec

^* From the Respiratory Epidemiology and Clinical Research Unit (Drs. Bourbeau and Schwartzman), Montréal Chest Institute of the Royal Victoria Hospital (Ms. Nault), McGill University Health Centre, Montréal, QC; Randomized Clinical Trial Unit (Mr. Ducruet and Dr. Collet), Jewish General Hospital, McGill University, Montréal, QC; and Manager Health Economics (Ms. Bradley), Boehringer-Ingelheim Canada, Burlington, ON, Canada. Members of the COPD axis of the Respiratory Health Network of the FRSQ who have participated in the research project are listed in the ^Appendix.

Correspondence to: Jean Bourbeau, MD, Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, 3650 St.Urbain, Office K1.32, Montréal, QC, Canada H2X 2P4; e-mail: jean.bourbeau{at}mcgill.ca

Abstract

Context: There is emerging evidence that disease management with self-management education provided by a case manager might benefit COPD patients.

Objective: To determine whether disease management with self-management education is more cost-effective than usual care among previously hospitalized COPD patients.

Design: Economic analysis in conjunction with a multicenter randomized clinical trial comparing patients conducting self-management with those receiving usual care over a 1-year follow-up period.

Setting: Respiratory referral centers.

Patients: One hundred ninety-one COPD patients who required hospitalization in the year preceding enrollment were recruited from seven respiratory outpatient clinics.

Intervention: In addition to usual care, patients in the intervention group received standardized education on COPD self-management program called "Living Well with COPD" with ongoing supervision by a case manager.

Main outcome measures: From the perspective of the health-care payer, we compared costs between the two groups and estimated the program cost per hospitalization prevented (incremental cost-effectiveness ratio of the program). We repeated these estimates for several alternate scenarios of patient caseload.

Results: The additional cost of the self-management program as compared to usual care, $3,778 (2004 Canadian dollars) per patient, exceeded the savings of $3,338 per patient based on the study design with a caseload of 14 patients per case manager. However, through a highly plausible sensitivity analysis, it was showed that if case managers followed up 50 patients per year, the self-management intervention would be cost saving relative to usual care (cost saving of $2,149 per patient; 95% confidence interval, $38 to $4,258). With more realistic potential caseloads of 50 to 70 patients per case manager, estimated program costs would be $1,326 and $1,016 per prevented hospitalization, respectively.

Conclusion: The program of self-management in COPD holds promise for positive economic benefits with increased patient caseload and rising costs of hospitalization.

Key Words: integrated care • patient education • management • medical care delivery