Cost-effectiveness of physical activity in the management of COPD patients in the UK
Received 23 July 2018
Accepted for publication 30 September 2018
Published 15 January 2019 Volume 2019:14 Pages 227—239
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Mafalda Ramos,1 Mark Lamotte,1 Laetitia Gerlier,1 Per Svangren,2 Anna Miquel-Cases,3 John Haughney4
1Real World Evidence Solutions, IQVIA, 1930 Zaventem, Belgium; 2Core Respiratory, Global Product and Portfolio Strategy – Global Payer Evidence and Pricing, AstraZeneca Gothenburg R&D, SE-431 83 Mölndal, Sweden; 3Global Price and Reimbursement, Global Payer Evidence and Pricing, AstraZeneca Gothenburg R&D, Cambridge CB2 8PA, UK; 4Academic Primary Care Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
Background: While the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines advise exercise to reduce disease progression, little investment in promoting physical activity (PA) is made by health care authorities. The purpose of this study was to estimate the cost-effectiveness of regular PA vs sedentary lifestyle in people with COPD in the UK.
Methods: Efficacy, quality of life, and economic evidence on the PA effects in COPD patients were retrieved from literature to serve as input for a Markov microsimulation model comparing a COPD population performing PA vs a COPD population with sedentary lifestyle. The GOLD classification defined the model health states. For the base case, the cost of PA was estimated at zero, a lifetime horizon was used, and costs and effects were discounted at 3.5%. Analyses were performed from the UK National Health Service (NHS) perspective. Uncertainty around inputs and assumptions were explored via scenario and sensitivity analyses, including a cost threshold analysis. Outcomes were cost/quality-adjusted life year (QALY) gained and cost/year gained.
Results: Based on our model, the effects of PA in the UK COPD population would be lower mortality (-6%), fewer hospitalizations (-2%), gains in years (+0.82) and QALYs (+0.66), and total cost savings of £2,568. The cost/QALY and cost/year gained were dominant. PA was cost-saving at costs <£35/month and cost-effective at cost <£202/month. The main model drivers were age and PA impact on death and hospital-treated exacerbations.
Conclusion: Including PA in the management of COPD leads to long-term clinical benefits. If the NHS promotes only exercise via medical advice, this would lead to health care cost savings. If the NHS chose to fund PA, it would still likely be cost-effective.
Keywords: cost-effectiveness, physical activity, exercise, COPD, microsimulation, Markov
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