Home-based pulmonary rehabilitation for COPD using minimal resources: An economic analysis

Respirology. 2020 Feb;25(2):183-190. doi: 10.1111/resp.13667. Epub 2019 Aug 16.


Background and objective: This study aimed to compare the cost-effectiveness and cost-utility of home and centre-based pulmonary rehabilitation for adults with stable chronic obstructive pulmonary disease (COPD).

Methods: Prospective economic analyses were undertaken from a health system perspective alongside a randomized controlled equivalence trial in which participants referred to pulmonary rehabilitation undertook a standard 8-week outpatient centre-based or a new home-based programme. Participants underwent clinical assessment prior to programme commencement, immediately following completion and 12 months following programme completion. They provided data for utility (quality-adjusted life years (QALY) determined using SF6D (utility scores for health states) calculated from 36-Item Short Form Health Survey version 2) and effectiveness (change in distance walked on 6-min walk test (Δ6MWD) following pulmonary rehabilitation ). Individual-level cost data for the 12 months following programme completion was sourced from healthcare administration and government databases.

Results: Between-group mean difference point estimates for cost (-$4497 (95% CI: -$12 250 to $3257), utility (0.025 (-0.038 to 0.086) QALY) and effectiveness (14 m (-11 to 39) Δ6MWD) favoured the home-based group. Cost-utility analyses demonstrated 63% of estimates falling in the dominant southeast quadrant and the probability that the new home-based model was cost-effective at a $0 threshold for willingness to pay was 78%. Results were robust to a range of sensitivity analyses. Programme completion was associated with significantly lower healthcare costs in the following 12 months.

Conclusion: Home-based pulmonary rehabilitation provides a cost-effective alternative model for people with COPD who cannot access traditional centre-based programmes.

Trial registration: ClinicalTrials.gov NCT01423227.

Keywords: chronic obstructive pulmonary disease; cost-benefit analysis; exercise therapy; healthcare costs; quality-adjusted life years.

Publication types

  • Comparative Study
  • Equivalence Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care / economics*
  • Cost-Benefit Analysis
  • Exercise Therapy
  • Female
  • Health Care Costs*
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Quality of Life
  • Quality-Adjusted Life Years
  • Self Care / economics*
  • Self Care / methods
  • Treatment Outcome
  • Walk Test

Associated data

  • ClinicalTrials.gov/NCT01423227