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February 15, 2019

Adding Exercise to COPD Treatment Is Cost-Effective, Simulation Study Says

Allison Inserro
Researchers in the United Kingdom used a Markov microsimulation model comparing a population with chronic obstructive pulmonary disease (COPD) performing physical activity vs a COPD population that was sedentary, in order to estimate the cost-effectiveness of regular PA vs a sedentary lifestyle.
Patients with chronic obstructive pulmonary disease may avoid physical activities that make them feel further breathlessness, which sets them up to lose even more physical conditioning, which in turn makes them less likely to make future exercise attempts. Although the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines advise exercise to reduce COPD disease progression, there is little investment in promoting physical activity (PA) by healthcare systems to prevent this vicious cycle.

Researchers in the United Kingdom used a Markov microsimulation model comparing a COPD population performing PA vs a COPD population that was sedentary. The purpose of this study was to estimate the cost-effectiveness of regular PA vs a sedentary lifestyle.

GOLD guidelines indicate pulmonary rehabilitation (PR) improves symptoms, QOL, and physical and emotional participation in everyday activities. As part of PR, smoking cessation and exercise are advised to try to slow disease progression by diminishing the intensity of lung function decline. But because exercise is seen more as a lifestyle change rather than a healthcare intervention, there has been little investment in promoting exercise in patients with COPD.

The researchers first performed a targeted literature review (TLR) to identify, collect, and summarize relevant evidence on the effects of PA in patients with COPD. This analysis identified studies reporting different forms of exercise in COPD patients: PA, Tai Chi, and PR, including information about reported efficacy, quality of life (QOL), and economic outcomes. The TLR formed the basis of a hypothesis that exercise/physical activity (PA) improves COPD outcomes and QOL. That informed a cost-effectiveness analysis (CEA), which aimed to demonstrate the long-term clinical and economic value of regular exercise in a COPD population compared with a COPD population with a sedentary lifestyle.

The outcomes of the cost-effectiveness analysis were reported as: number of hospitalizations due to severe exacerbations, mortality at 5 years, incremental life years (LY), incremental QALYs, incremental total costs, cost per life-year gained (incremental cost-effectiveness ratio [ICER]), cost per quality-adjusted life year gained (incremental cost-utility ratio [ICUR]), and net monetary benefit (NMB). Future costs and effects were discounted at 3.5% per year.

In the microsimulation of those taking part in PA, patients performing PA had less event costs (−£2,568), lower mortality (−6%), and lower number of hospitalizations (−2%), as compared with a sedentary lifestyle. In addition, patients had less severe disease for a longer amount of time. They also accumulated increased life years (+0.82) and more QALYs (+0.66), compared with a sedentary lifestyle.

Since mortality was lower, disease management costs were higher in the PA arm compared to sedentary lifestyle. But the increase was offset by savings in event costs, resulting in a total discounted cost savings of −£2,568.

These outcomes resulted in a dominant ICER and ICUR. For a willingness to pay of £20,000 per QALY, the NMB was £15,807

Reference

Ramos M, Lamotte M, Gerlier L, Svangren P, Miquel-Cases A, Haughney J. Cost-effectiveness of physical activity in the management of COPD patients in the UK. [publihsed online January 15, 2019]. Int J Chron Obstruct Pulmon Dis. doi:10.2147/COPD.S181194.

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