Introduction Chronic Obstructive Pulmonary Disease (COPD) is a long-term condition characterised by breathlessness. The WHO has projected a 30% increase in total COPD deaths worldwide over the next decade. In 2012, COPD accounted for 29,776 deaths in the UK, and it costs the NHS over £8,000,000 annually.
Method This systematic review was conducted via searches on PubMed, using key words ‘COPD’, ‘Management’, ‘Cost-effectiveness’, ‘exercise’, ‘QALY’, ‘UK’ and ‘Pulmonary Rehabilitation’. Studies with non-cost-effective interventions were removed. Studies using ‘Quality Adjusted Life Years’ and/or ‘Incremental cost-effectiveness ratio’ were considered for this review. Prices were adjusted for inflation.
Results Studies reviewed suggest that current standard care is cost-effective by NICE standards (£20,000 to £30,000 per QALY). Cost effectiveness was improved with the addition of roflumilast to ICS/LABA therapy, where adding roflumilast led to an ICER of £24,976 per QALY gained for severe and very severe COPD in 2018. Tiotropium (£1934–£2548 in 2018] per QALY) proved to be a superior treatment over ipratropium (£2256–£2973 in 2018] per QALY) and salmeterol (£2143–£2823 in 2018] per QALY). Umeclidinium bromide added onto ICS/LABA therapy led to an ICER of £1310 per QALY, an improvement over Tiotropium. Adding pulmonary rehabilitation to treatment for COPD was likely to result in financial benefits, with mean incremental cost of adding PR was -£152 (-£200 in 2018). Physical activity improved cost-effectiveness versus sedentary lifestyle, reducing exacerbations and increasing QALYs.
Conclusion Current medical management is well optimized with regards to price per QALY gained. Umeclidinium should be considered for treatment instead of tiotropium. Physical Activity reduces exacerbations, increases QALYs and improves cost-effectiveness. However, data on cost-effectiveness of PR for COPD were insufficient. Furthermore, cost-effectiveness data of medical treatment should be updated as drug prices may have changed.
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