Pulmonary Rehabilitation Effective at Reducing Costs for Patients With COPD

A study published in JAMA Network Open found that pulmonary rehabilitation (PR) was effective at reducing costs for patients with chronic obstructive pulmonary disease (COPD) after a hospitalization. They also found improvements in quality-adjusted life expectancy (QALE) for patients who went to PR.

The researchers created a Markov microsimulation model of outcomes after a hospital discharge for a COPD-related hospitalization. They compared a situation with universal PR vs no PR in the US health care system, and they used a lifetime time horizon but assumed that PR would occur within 90 days of index admission, PR would not continue after the first year, and PR would have no cost outcomes beyond the first year.

Data came from literature published between October 1, 2001, and April 1, 2021. The primary data source for this study was an analysis of Medicare beneficiaries who were living with COPD between January 1, 2014, and December 31, 2015; patients in this study had a mean age of 76.9 years and 58.6% of them were women.

Model parameters were taken from 2 analyses of fee-for service Medicare enrollees who were 65 years or older and hospitalized for COPD in 2014. Estimates from the propensity-matched cohorts were used for 1-year mortality, hospital readmission, and number of days per person-year in the hospital calculations. All costs were represented in 2020 US$.

PR was demonstrated as having a lifetime net cost savings of $5721 (95% prediction interval, $3307-$8388) per patient and an improved QALE (gain of 0.53 years; 95% prediction interval, 0.43-0.63) due to reductions in number of days in the hospital or skilled nursing facility.

Researchers found that the savings in the first year after hospitalization were $8226 (95% prediction interval, $5348-10,873); mean savings in the first year were $8667 per patient for the health system perspective.

PR remained cost saving even if it only prevented readmissions and didn’t improve quality of life or mortality (mean savings, $7607 per patient) unless the HR for readmission was less than 0.89. Incremental quality-adjusted life-years would decrease to 0.41 (compared with 0.43) if PR did not improve quality of life but reduced rehospitalizations and mortality.

There were some limitations to this study. The results of this study depend on the validity of the model; validity, precision, and applicability of the data used for parameters; and the extent of plausible scenarios being explored. The study’s primary source used propensity weighting to account for differences between patients who used PR and did not use PR. However, estimates of the distribution of Global Initiative for Obstructive Lung Disease stages came from European studies that may not be generalizable.

The analysis used the distribution of attended PR visits rather than a completed PR course, which may underestimate cost and effectiveness. Costs vary by region, which may have led to an underestimation of cost of PR in specific locations. The results of the study were also not validated.

The researchers concluded that their study suggests that PR was effective in saving money in patients who had been hospitalized with COPD. QALE was also improved in patients with COPD who underwent PR after hospitalization.

“Given these findings, payers­—particularly Medicare—would identify policies that would increase access and adherence to PR programs for patients living with COPD,” the authors wrote.

Reference

Mosher CL, Nanna MG, Jawitz OK, et al. Cost-effectiveness of pulmonary rehabilitation among US adults with chronic obstructive pulmonary disease. JAMA Netw Open. 2022;5(6):e2218189. doi:10.1001/jamanetworkopen.2022.18189