Economic benefits of self-management education in COPD.

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.