Cost-effectiveness of an integrated care program for COPD: The RECODE cluster randomized trial

Background We conducted a cost-effectiveness analysis of a COPD disease management (COPD-DM) program in primary care in the Netherlands. A multidisciplinary team was mainly trained in motivational interviewing, setting-up individual care plan, managing exacerbations, and implementing clinical guidelines. In addition, clinical decision making was supported by audit and feedback reports provided by an ICT program. Methods In the two-year cluster-randomized RECODE trial (1086 COPD patients, 40 clusters), the COPD-DM program was compared to usual care. We investigated health outcomes (CCQ, exacerbations, SGRQ, MRC, EQ-5D) and 2-year costs from a healthcare and a societal perspective. Results Intervention costs (training, ICT) were about €325 per patient. Excluding these costs, we found significantly higher healthcare costs in the intervention group: difference €408 (95% CI €124 to €659). Also from a societal perspective, costs were higher: difference €954 (95% CI €201 to €1606), when excluding intervention costs. Health outcomes were similar in both groups, except for a lower number of QALYs in the intervention group: difference -0.037 (95% CI -0.069 to -0.006). Conclusion The RECODE intervention was not found to be cost-effective during the 2-year follow-up period. One of the reasons might be the suboptimal implementation of the RECODE interventions, which were merely professional-oriented, into daily practice.