Cost-effectiveness of a self-management maintenance programme following pulmonary rehabilitation: a UK randomised controlled trial for patients with chronic obstructive pulmonary disease
Bibliographic record
Abstract
INTRODUCTION: Pulmonary rehabilitation (PR) is an effective intervention for patients with chronic obstructive pulmonary disease (COPD) but impact typically only lasts 6-12 months. This paper presents results of an economic evaluation of a PR maintenance programme (Self-management Programme of Activity, Coping and Education (SPACE)) undertaken within a prospective assessor-blind randomised controlled trial. METHODS: Adults with COPD who had completed PR within the previous 4 weeks were randomised to SPACE or best usual care. Healthcare use, personal expenditure and societal costs were recorded at baseline, 6 and 12 months. SPACE costs included staff training, materials and delivery of group sessions. Health utility recorded (EQ-5D-5L) with analysis comparing differences in mean values at 6 and 12 months, over baseline utility scores. Observed changes compared with threshold for COPD clinical significance. Incremental cost-effectiveness ratios estimated from National Health Service and societal perspectives. Cost per quality-adjusted life-year (QALY) values compared with willingness-to-pay threshold (≤£30 000). Uncertainties in costs and outcomes incorporated into a sensitivity analysis. Missing values imputed using a Bayesian mixed model with confounders. RESULTS: 116 patients recruited between October 2019 and June 2022 (57 intervention and 59 control). No significant differences at baseline in age, body mass index, smoking, forced expiratory volume in 1 s and health utility (EQ-5D-5L). Mean healthcare costs in the SPACE group were £139.72 lower per patient over 12 months compared with usual care. At 12 months, the SPACE group retained higher (p=0.04) utility value 0.7609 (SE=0.0238) versus control patients 0.6738 (SE=0.0348). The recorded 0.1178 advantage in mean QALY values (p<0.05) is above the threshold (0.051) for COPD significance. Cost-effectiveness acceptability curves indicate a 97% chance of achieving £20 000 per QALY. Patient and societal costs increase this percentage. DISCUSSION: This study addresses an important gap in current evidence for non-pharmacological COPD interventions. The PR maintenance programme (SPACE) is shown to be highly cost-effective at 12 months. Future research should consider cost-effectiveness of telerehabilitation programmes, as well as tailored digital support beyond 12 months.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".