(Cost‐)effectiveness of self‐treatment of exacerbations in patients with COPD: 2 years follow‐up of a RCT. Issue 3 (9th December 2015)

• Record Type: Journal Article
• Authors: Zwerink, Marlies; Kerstjens, Huib AM; van der Palen, Job; van der Valk, Paul; Brusse‐Keizer, Marjolein; Zielhuis, Gerhard; Effing, Tanja
• Is Part Of: Respirology. Volume 21:Issue 3(2016)
• Page Start: 497
• Page End: 503
• Publication Date: 2015-12-09
• Subjects: chronic obstructive pulmonary disease -- cost‐effectiveness -- exacerbation -- quality of life -- self‐management; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.12697
• Languages: English
• ISSNs: 1323-7799

Abstract

Abstract: Background and objective: Long‐term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost‐)effectiveness of a self‐management programme with or without self‐treatment of exacerbations after 2 years follow‐up. Methods: Self‐management with or without self‐treatment of exacerbations was randomly assigned to patients. All patients participated in four self‐management meetings. Patients in the self‐treatment group (STG) also learned to use an action plan to start a course of prednisolone and/or antibiotics in case of worsening of symptoms. Primary outcome was the duration and severity of exacerbations. Results: Data of 70 COPD patients in the STG and 72 patients in the control group (CG) were analysed. Over 2 years, the median number of exacerbation days was significantly lower in the STG (50, IQR: 32–115) compared with the CG (82, IQR: 22–186) ( P = 0.047), as was the mean symptom score of an exacerbation (STG: 43.4, IQR 27.2–68.6 vs CG: 55.9, IQR: 31.2–96.8) ( P = 0.029). Also, patients in the STG visited the respiratory physician and emergency department less frequently than patients in the CG with incidence rate ratios of 1.52 (95% CI: 1.28–1.79) and 2.27 (95% CI: 1.11–4.62), respectively. Direct medical costs per patient over 2 years were €1078 lower in the STG. Conclusion: Self‐treatment of exacerbations is beneficial in COPD patients without significant comorbidities because it reduces exacerbation duration, exacerbation severity and health‐care utilization leading to considerable cost savings. Abstract : Adding self‐treatment of exacerbations to a self‐management programme led to fewer exacerbation days, less severe exacerbations, fewer respiratory physician and emergency department visits after 2 years of follow‐up in patients with COPD. This led to a considerable reduction in costs.