Background Pulmonary rehabilitation (PR) is a complex intervention aimed at decreasing morbidity in patients with long-term lung conditions such as COPD, bronchiectasis and pulmonary fibrosis. In the NHS setting, it is an 8 week programme consisting of exercise training to reduce functional decline, and education to aid patients with self-management of their condition. Extensive evidence exists in support of the clinical effectiveness of PR but there is a paucity of studies evaluating the economics of PR. This review aimed to evaluate cost-effectiveness studies of PR programmes worldwide.
Methods A systematic review was conducted in accordance with PRISMA guidelines. A thorough literature search strategy was employed across PubMed, the Cost-Effectiveness Analysis Registry (CEA Registry), National Health Service Economic Evaluation Database (NHS EED), Physiotherapy Evidence Database (PEDro) and Google Scholar from inception to October 2019 for studies comparing the cost-effectiveness of PR programmes with that of usual care. Included studies had to meet the Cochrane definition of PR; at minimum, exercise training for at least 4 weeks. Cost-effectiveness measures included cost per quality-adjusted life year (QALY), cost per clinically significant outcome, incremental cost-effectiveness ratio (ICER) and/or cost savings to the healthcare system involved. These findings were then narratively synthesised.
Results 8 studies consisting of 1437 patients were included. Settings for the PR programmes were UK, Ireland, France, Netherlands, Canada and Australia. 7 studies included COPD patients only. 1 study assessing the uncertainties around the cost and outcome found that the cost per QALY was below £17000, below the willingness to pay threshold suggested by the NICE. Evidence from the studies suggests that PR is cost-effective with savings for the healthcare provider involved.
Conclusion PR is a cost-effective intervention with potential savings for the service providers. Future studies should examine whether cost-effectiveness varies with the age of patients undergoing PR.
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