The (Cost)-Effectiveness of Self-Treatment of Exacerbations on the Severity of Exacerbations in COPD Patients : The COPE II-Study

COPD is a chronic disease with high prevalence and quickly increasing incidence rates. We evaluated the effect of self-treatment of COPD exacerbations on the severity of exacerbations during one year. In addition, a cost-effectiveness analysis was performed. Patients were randomly allocated to four two-hour self-management sessions, with or without training in self-treatment of exacerbations. Patients in the self-treatment group received an action plan with the possibility to initiate a prednisolone course (with or without antibiotics). During follow up all participants kept a daily symptom diary. These provided the data to calculate the frequency of exacerbations, the number of exacerbation days and mean daily severity scores. Data were analysed of 142 randomised patients (self-treatment: n=70; control: n=72). The frequency of exacerbations was identical in both study groups (mean 3.5 (SD 2.7)). Patients in the self-treatment group reported fewer exacerbation days (median self-treatment: 31(interquartile range (IQR): 8.9-67.5); control: 40 (IQR: 13.3-88.2); p=0.064), the difference was significant in the group of patients with a high number of exacerbation days per year (>137 (= 90th percentile of the whole study population); p=0.028). The mean severity score of an exacerbation day was equal in both groups. No between-group differences were found in health related quality of life. Cost-effectiveness analyses showed that applying self-treatment saved €154 per patient, with a trend towards a lower probability for hospitalisations (number/patient/year: self-treatment: 0.20 versus control: 0.33 (p=0.388)) and a significant reduction of health care contacts (number/patient/year: self-treatment: 5.37 versus control: 6.51 (p=0.043)). We conclude that self-treatment of exacerbations incorporated in a self-management programme leads to less exacerbation days and lower costs. This study showed that self-treatment of exacerbations leads to fewer exacerbation days in combination with an increase in the use of courses of prednisolone and antibiotics. No between-group differences in the number of exacerbations, average daily severity score, and hrqol were found. Cost-effectiveness analyses showed that the self-treatment strategy was dominant over (i.e. Compared favourably with) the control strategy with lower probabilities for hospitalisations and health care contacts in the self-treatment group, combined with cost savings.