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Jean Bourbeau,1 Denis Granados,2 Stéphane Roze,3 Isabelle Durand-Zaleski,4 Pere Casan,5 Dieter Köhler,6 Silvia Tognella,7 Jose Luis Viejo,8 Roberto W Dal Negro,9 Romain Kessler10 1Department of Medicine, Division of Experimental Medicine, Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada; 2Medical R&D–Real World & Clinical Evidence, Air Liquide Santé International, Gentilly, France; 3Department of Health Economics, HEVA HEOR, Lyon, France; 4URCEco Ile de France Hôpital de l’Hotel Dieu, Paris, France; 5Department of Pneumology, Asturias University Hospital, Oviedo, Spain; 6Department of Internal Medicine, Kloster Grafschaft Specialised Hospital, Schmallenberg, Germany; 7Department of Pneumology, Bussolengo General Hospital, Bussolengo, Italy; 8Department of Pneumology, Burgos University Hospital, Burgos, Spain; 9Department of Pneumology, Bussolengo Hospital, Bussolengo, Italy; 10Department of Pneumology, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France Purpose: Efficient management of COPD represents an international challenge. Effective management strategies within the means of limited health care budgets are urgently required. This analysis aimed to evaluate the cost-effectiveness of a home-based disease management (DM) intervention vs usual management (UM) in patients from the COPD Patient Management European Trial (COMET). Methods: Cost-effectiveness was evaluated in 319 intention-to-treat patients over 12 months in COMET. The analysis captured unplanned all-cause hospitalization days, mortality, and quality-adjusted life expectancy. Costs were evaluated from a National Health Service perspective for France, Germany, and Spain, and in a pooled analysis, and were expressed in 2015 Euros (EUR). Quality of life was assessed using the 15D health-related quality-of-life instrument and mapped to utility scores. Results: Home-based DM was associated with improved mortality and quality-adjusted life expectancy. DM and UM were associated with equivalent direct costs (DM reduced costs by EUR -37 per patient per year) in the pooled analysis. DM was associated with lower costs in France (EUR -806 per patient per year) and Spain (EUR -51 per patient per year), but higher costs in Germany (EUR 391 per patient per year). Evaluation of cost per death avoided and cost per quality-adjusted life year (QALY) gained showed that DM was dominant (more QALYs and cost saving) in France and Spain, and cost-effective in Germany vs UM. Nonparametric bootstrapping analysis, assuming a willingness-to-pay threshold of EUR 20,000 per QALY gained, indicated that the probability of home-based DM being cost-effective vs UM was 87.7% in France, 81.5% in Spain, and 75.9% in Germany. Conclusion: Home-based DM improved clinical outcomes at equivalent cost vs UM in France and Spain, and in the pooled analysis. DM was cost-effective in Germany with an incremental cost-effectiveness ratio of EUR 2,541 per QALY gained. The COMET home-based DM intervention could represent an attractive alternative to UM for European health care payers. Keywords: cost-effectiveness, France, Spain, Germany, home-based disease management, COPD |
