COST-EFFECTIVENESS OF A COPD DISEASE MANAGEMENT PROGRAM IN PRIMARY CARE: THE RECODE CLUSTER RANDOMIZED TRIAL

Objectives: Disease management programs for chronic obstructive pulmonary disease (herein, COPD-DM) are currently implemented on a broad scale in the Netherlands. However, the evidence about their cost-effectiveness is still inconclusive. We aimed to conduct a cost-effectiveness analysis of a COPD-DM program in primary care in the Netherlands, called RECODE. In RECODE, a multidisciplinary primary care team was trained in motivational interviewing to improve life style, setting-up individual care plans, early recognizing and managing of exacerbations, and implementing clinical guidelines. In addition, clinical decision making was supported by audit and feedback reports provided by an ICT program and reimbursement of physical reactivation by a physiotherapist was provided. Methods: In a two-year cluster-randomized controlled trial (1086 COPD patients, 40 clusters), the COPD-DM program was compared to usual care. As part of this trial we conducted a cost-effectiveness analysis to relate the effect of the COPD-DM on intermediate and final health outcomes to the costs from a health care and a societal perspective. Detailed self-reported health care utilization data were collected during the trial-period. Results: The 2-year intervention costs of the training for professionals, the ICT, and the audit and feedback reports were estimated to be € 324 per patient. Excluding these costs, the intervention group had € 584 (95% CI € 86 to € 1,046) higher health care costs and € 645 (95% CI € 28 to € 1,190) higher costs from the societal perspective compared to the usual care group. Health outcomes were similar in both groups, except for 0.04 (95% CI -0.07 to -0.01) less quality-adjusted life-years in the intervention group. Conclusions: RECODE was not cost-effective during the 2-year follow-up period. This is most likely due to the fact that the interventions targeted professionals instead of patients and were suboptimally implemented, the relatively mild COPD population, and the national reforms in COPD care that affected the usual care group.