Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial

Charles Yan (), Jeff Round, Ilke Akpinar, Chantal E. Atwood, Lesly Deuchar, Mohit Bhutani, Richard Leigh and Michael K. Stickland
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Charles Yan: Institute of Health Economics
Jeff Round: University of Alberta
Ilke Akpinar: University of Alberta
Chantal E. Atwood: Alberta Health Services
Lesly Deuchar: Alberta Health Services
Mohit Bhutani: University of Alberta
Richard Leigh: University of Calgary
Michael K. Stickland: University of Alberta

PharmacoEconomics - Open, 2023, vol. 7, issue 3, No 14, 493-505

Abstract: Abstract Background Appropriate management of chronic obstructive pulmonary disease (COPD) patients following acute exacerbations can reduce the risk of future exacerbations, improve health status, and lower care costs. While a transition care bundle (TCB) was associated with lower readmissions to hospitals than usual care (UC), it remains unclear whether the TCB was associated with cost savings. Objective The aim of this study was to evaluate how this TCB was associated with future Emergency Department (ED)/outpatient visits, hospital readmissions, and costs in Alberta, Canada. Methods Patients who were aged 35 years or older, who were admitted to hospital for a COPD exacerbation, and had not been treated with a care bundle received either TCB or UC. Those who received the TCB were then randomized to either TCB alone or TCB enhanced with a care coordinator. Data collected were ED/outpatient visits, hospital admissions and associated resources used for index admissions, and 7-, 30- and 90-day post-index discharge. A decision model with a 90-day time horizon was developed to estimate the cost. A generalized linear regression was conducted to adjust for imbalance in patient characteristics and comorbidities, and a sensitivity analysis was conducted on the proportion of patients’ combined ED/outpatient visits and inpatient admissions as well as the use of a care coordinator. Results Differences in length of stay (LOS) and costs between groups were statistically significant, although with some exceptions. Inpatient LOS and costs were 7.1 days (95% confidence interval [CI] 6.9–7.3) and Canadian dollars (CAN$) 13,131 (95% CI CAN$12,969–CAN$13,294) in UC, 6.1 days (95% CI 5.8–6.5) and CAN$7634 (95% CI CAN$7546–CAN$7722) in TCB with a coordinator, and 5.9 days (95% CI 5.6–6.2) and CAN$8080 (95% CI CAN$7975–CAN$8184) in TCB without a coordinator. Decision modelling indicated TCB was less costly than UC, with a mean (standard deviation [SD]) of CAN$10,172 (40) versus CAN$15,588 (85), and TCB with a coordinator was slightly less costly than without a coordinator (CAN$10,109 [49] versus CAN$10,244 [57]). Conclusion This study suggests that the use of the TCB, with or without a care coordinator, appears to be an economically attractive intervention compared with UC.

Date: 2023
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DOI: 10.1007/s41669-023-00400-7

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