Effectiveness and Costs of Nutritional Intervention Integrated in an INTERdisciplinary COMmunity-Based COPD Management Program (INTERCOM) in Patients with Less Advanced COPD

C.R. van Wetering, M. Hoogendoorn, MSc, D.R. De Munck, MSc, M.P. Rutten-van Molken, PhD, A.M. Schols, PhD, Veldhoven, Rotterdam, Maastricht, The Netherlands

Am J Respir Crit Care Med 179;2009:A5373: [Publication Page: A5373]

Background: The effectiveness of pulmonary rehabilitation in severe COPD is well established but no data of cost-effectiveness is available in less advanced COPD.

Methods: In this 2-year randomized, controlled parallel-group trial 199 patients were enrolled. Outcomes at 4, 12 and 24 months: Health status by SGRQ, exercise capacity by cycle endurance time (CET)and 6
min walking distance (WD), dyspnea by MRC and perceived effectiveness by 5-point Likert scale. Costs were obtained from cost diaries, hospital administrations and local pharmacies.

Results: Between group differences (mean (SE)) after 4 months: SGRQ total score: 4.06 (1.39) p=0.04, CET: 221 (104) sec, p=0.04, WD 13 (6) m, p= 0.02 and MRC score: 0.33 (0.13), p=0.01, all in favor of
INTERCOM. The differences in functional exercise capacity increased. At 2 years they were: CET:278 (136) sec, p=0.04, WD 25 (11), p= 0.03. Over the entire 2-yr period the estimated differences in SGRQ
and MRC were: 2.60 (1.3), p=0.04 and 0.21 (0.1), p=0.048, respectively. Perceived effectiveness significantly favored the INTERCOM program (p<0.001). Total 2-year costs were 2,751 euro (95% CI: -
632:6,372) higher in the INTERCOM than in the Usual care group. The incremental cost-effectiveness ratios were 32,524 euro/QALY or 9,078 euro per additional patient with a relevant improvement in SGRQ.

Interpretation: This is the first study showing that a multidisciplinary, community-based disease management program is also cost-effective in patients with less advanced airflow obstruction.