Clinical and cost-effectiveness of pulmonary rehabilitation for people with post-tuberculosis lung disease in Kyrgyzstan: A Single-blind Randomized Controlled Trial

Rationale Tuberculosis (TB) is a major worldwide cause of disability, with TB survivors experiencing significant and often under-recognised burden, and approximately half going on to develop post-tuberculosis lung disease (PTLD). Pulmonary rehabilitation may offer effective disease management but there is a lack of evidence in PTLD populations. Objectives We aimed to determine the clinical and cost effectiveness of pulmonary rehabilitation for adults living with PTLD in Kyrgyzstan. Methods A single-blind randomised controlled trial, conducted March 2021 to June 2022 in Bishkek, Kyrgyzstan, compared supervised PR to usual care for adults living with PTLD. Participants were randomised (1:1) to receive either usual care (control) or culturally adapted pulmonary rehabilitation (intervention), comprising individually prescribed and tailored exercise and self-management education. The primary outcome was change in maximal exercise capacity, measured by the incremental shuttle walking test (ISWT), from baseline to the end of 6-weeks of pulmonary rehabilitation, analysed by intention-to-treat analysis. Secondary outcomes included health-related quality of life (HRQoL) and cost-effectiveness analysis. Results 114 participants (mean ± SD 43.3 ± 15.2 years, 57% male) received either supervised pulmonary rehabilitation or usual care. Compared with the control group, changes in exercise capacity and HRQoL from baseline were significantly greater in the intervention group (ISWT: 123.0 m, 95%CI 81.2-164.8, P < .001; EQ-5D-5L VAS: 20.2, 95% CI 15.5-24.9, P < .0001). The intervention group saw a significant increase in quality-adjusted life years (QALYs) over the control group (0.2 [95%CI 0.1-0.2]). We calculated a total programme cost of U.S.$5,686.5 (U.S.$95 per patient who received pulmonary rehabilitation), giving a programme cost, after adjusting for purchasing power, of U.S.$2,143.2 per QALY [95%CI 1,621.9-2,663.9]. Conclusions In adults with PTLD in Kyrgyzstan, a culturally adapted pulmonary rehabilitation programme significantly improved exercise capacity and HRQoL compared with usual care and was both clinically and cost effective.