(Cost-)effectiveness of self-treatment of exacerbations in patients with COPD: 2 years follow-up of a RCT

Marlies Zwerink, Huib A.M. Kerstjens, Jacobus Adrianus Maria van der Palen, Paul van der Valk, Marjolein Brusse-Keizer, Gerhard Zielhuis, T.W. Effing

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Abstract

Background and objective Long-term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost-)effectiveness of a self-management programme with or without self-treatment of exacerbations after 2 years follow-up. Methods Self-management with or without self-treatment of exacerbations was randomly assigned to patients. All patients participated in four self-management meetings. Patients in the self-treatment group (STG) also learned to use an action plan to start a course of prednisolone and/or antibiotics in case of worsening of symptoms. Primary outcome was the duration and severity of exacerbations. Results Data of 70 COPD patients in the STG and 72 patients in the control group (CG) were analysed. Over 2 years, the median number of exacerbation days was significantly lower in the STG (50, IQR: 32–115) compared with the CG (82, IQR: 22–186) (P = 0.047), as was the mean symptom score of an exacerbation (STG: 43.4, IQR 27.2–68.6 vs CG: 55.9, IQR: 31.2–96.8) (P = 0.029). Also, patients in the STG visited the respiratory physician and emergency department less frequently than patients in the CG with incidence rate ratios of 1.52 (95% CI: 1.28–1.79) and 2.27 (95% CI: 1.11–4.62), respectively. Direct medical costs per patient over 2 years were €1078 lower in the STG. Conclusion Self-treatment of exacerbations is beneficial in COPD patients without significant comorbidities because it reduces exacerbation duration, exacerbation severity and health-care utilization leading to considerable cost savings.
Original languageEnglish
Pages (from-to)497-503
JournalRespirology
Volume21
Issue number3
DOIs
Publication statusPublished - 9 Dec 2016

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Chronic Obstructive Pulmonary Disease
Cost-Benefit Analysis
Therapeutics
Control Groups
Self Care
Patient Acceptance of Health Care
Cost Savings
Prednisolone
Hospital Emergency Service
Comorbidity
Anti-Bacterial Agents
Physicians
Costs and Cost Analysis
Incidence

Keywords

  • METIS-314004
  • IR-98850

Cite this

Zwerink, M., Kerstjens, H. A. M., van der Palen, J. A. M., van der Valk, P., Brusse-Keizer, M., Zielhuis, G., & Effing, T. W. (2016). (Cost-)effectiveness of self-treatment of exacerbations in patients with COPD: 2 years follow-up of a RCT. Respirology, 21(3), 497-503. https://doi.org/10.1111/resp.12697
Zwerink, Marlies ; Kerstjens, Huib A.M. ; van der Palen, Jacobus Adrianus Maria ; van der Valk, Paul ; Brusse-Keizer, Marjolein ; Zielhuis, Gerhard ; Effing, T.W. / (Cost-)effectiveness of self-treatment of exacerbations in patients with COPD: 2 years follow-up of a RCT. In: Respirology. 2016 ; Vol. 21, No. 3. pp. 497-503.
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abstract = "Background and objective Long-term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost-)effectiveness of a self-management programme with or without self-treatment of exacerbations after 2 years follow-up. Methods Self-management with or without self-treatment of exacerbations was randomly assigned to patients. All patients participated in four self-management meetings. Patients in the self-treatment group (STG) also learned to use an action plan to start a course of prednisolone and/or antibiotics in case of worsening of symptoms. Primary outcome was the duration and severity of exacerbations. Results Data of 70 COPD patients in the STG and 72 patients in the control group (CG) were analysed. Over 2 years, the median number of exacerbation days was significantly lower in the STG (50, IQR: 32–115) compared with the CG (82, IQR: 22–186) (P = 0.047), as was the mean symptom score of an exacerbation (STG: 43.4, IQR 27.2–68.6 vs CG: 55.9, IQR: 31.2–96.8) (P = 0.029). Also, patients in the STG visited the respiratory physician and emergency department less frequently than patients in the CG with incidence rate ratios of 1.52 (95{\%} CI: 1.28–1.79) and 2.27 (95{\%} CI: 1.11–4.62), respectively. Direct medical costs per patient over 2 years were €1078 lower in the STG. Conclusion Self-treatment of exacerbations is beneficial in COPD patients without significant comorbidities because it reduces exacerbation duration, exacerbation severity and health-care utilization leading to considerable cost savings.",
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Zwerink, M, Kerstjens, HAM, van der Palen, JAM, van der Valk, P, Brusse-Keizer, M, Zielhuis, G & Effing, TW 2016, '(Cost-)effectiveness of self-treatment of exacerbations in patients with COPD: 2 years follow-up of a RCT' Respirology, vol. 21, no. 3, pp. 497-503. https://doi.org/10.1111/resp.12697

(Cost-)effectiveness of self-treatment of exacerbations in patients with COPD: 2 years follow-up of a RCT. / Zwerink, Marlies; Kerstjens, Huib A.M.; van der Palen, Jacobus Adrianus Maria; van der Valk, Paul; Brusse-Keizer, Marjolein; Zielhuis, Gerhard; Effing, T.W.

In: Respirology, Vol. 21, No. 3, 09.12.2016, p. 497-503.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - (Cost-)effectiveness of self-treatment of exacerbations in patients with COPD: 2 years follow-up of a RCT

AU - Zwerink, Marlies

AU - Kerstjens, Huib A.M.

AU - van der Palen, Jacobus Adrianus Maria

AU - van der Valk, Paul

AU - Brusse-Keizer, Marjolein

AU - Zielhuis, Gerhard

AU - Effing, T.W.

PY - 2016/12/9

Y1 - 2016/12/9

N2 - Background and objective Long-term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost-)effectiveness of a self-management programme with or without self-treatment of exacerbations after 2 years follow-up. Methods Self-management with or without self-treatment of exacerbations was randomly assigned to patients. All patients participated in four self-management meetings. Patients in the self-treatment group (STG) also learned to use an action plan to start a course of prednisolone and/or antibiotics in case of worsening of symptoms. Primary outcome was the duration and severity of exacerbations. Results Data of 70 COPD patients in the STG and 72 patients in the control group (CG) were analysed. Over 2 years, the median number of exacerbation days was significantly lower in the STG (50, IQR: 32–115) compared with the CG (82, IQR: 22–186) (P = 0.047), as was the mean symptom score of an exacerbation (STG: 43.4, IQR 27.2–68.6 vs CG: 55.9, IQR: 31.2–96.8) (P = 0.029). Also, patients in the STG visited the respiratory physician and emergency department less frequently than patients in the CG with incidence rate ratios of 1.52 (95% CI: 1.28–1.79) and 2.27 (95% CI: 1.11–4.62), respectively. Direct medical costs per patient over 2 years were €1078 lower in the STG. Conclusion Self-treatment of exacerbations is beneficial in COPD patients without significant comorbidities because it reduces exacerbation duration, exacerbation severity and health-care utilization leading to considerable cost savings.

AB - Background and objective Long-term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost-)effectiveness of a self-management programme with or without self-treatment of exacerbations after 2 years follow-up. Methods Self-management with or without self-treatment of exacerbations was randomly assigned to patients. All patients participated in four self-management meetings. Patients in the self-treatment group (STG) also learned to use an action plan to start a course of prednisolone and/or antibiotics in case of worsening of symptoms. Primary outcome was the duration and severity of exacerbations. Results Data of 70 COPD patients in the STG and 72 patients in the control group (CG) were analysed. Over 2 years, the median number of exacerbation days was significantly lower in the STG (50, IQR: 32–115) compared with the CG (82, IQR: 22–186) (P = 0.047), as was the mean symptom score of an exacerbation (STG: 43.4, IQR 27.2–68.6 vs CG: 55.9, IQR: 31.2–96.8) (P = 0.029). Also, patients in the STG visited the respiratory physician and emergency department less frequently than patients in the CG with incidence rate ratios of 1.52 (95% CI: 1.28–1.79) and 2.27 (95% CI: 1.11–4.62), respectively. Direct medical costs per patient over 2 years were €1078 lower in the STG. Conclusion Self-treatment of exacerbations is beneficial in COPD patients without significant comorbidities because it reduces exacerbation duration, exacerbation severity and health-care utilization leading to considerable cost savings.

KW - METIS-314004

KW - IR-98850

U2 - 10.1111/resp.12697

DO - 10.1111/resp.12697

M3 - Article

VL - 21

SP - 497

EP - 503

JO - Respirology

JF - Respirology

SN - 1323-7799

IS - 3

ER -