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Observational Cost-Effectiveness Analysis Using Routine Data: Admission and Discharge Care Bundles for Patients with Chronic Obstructive Pulmonary Disease

Author

Listed:
  • Padraig Dixon

    (University of Bristol
    University of Bristol, Oakfield House)

  • William Hollingworth

    (University of Bristol)

  • Jonathan Benger

    (University of the West of England)

  • James Calvert

    (North Bristol Trust, Southmead Hospital)

  • Melanie Chalder

    (University of Bristol)

  • Anna King

    (University of Bristol)

  • Stephanie MacNeill

    (University of Bristol)

  • Katherine Morton

    (University of the West of England)

  • Emily Sanderson

    (University of Bristol)

  • Sarah Purdy

    (University of Bristol)

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease, and accounts for a substantial proportion of unplanned hospital admissions. Care bundles for COPD are a set of standardised, evidence-based interventions that may improve outcomes in hospitalised COPD patients. We estimated the cost effectiveness of care bundles for acute exacerbations of COPD using routinely collected observational data. Methods Data were collected from implementation (n = 7) and comparator (n = 7) acute hospitals located in England and Wales. We conducted a difference-in-difference cost-effectiveness analysis using a secondary care (i.e. hospital) perspective to examine the effect on National Health Service (NHS) costs and 90-day mortality of implementing care bundles compared with usual care for patients admitted to hospital with an acute exacerbation of COPD. Adjusted models included as covariates patient age, sex, deprivation, ethnicity and seasonal effects and mixed effects for site. Results Outcomes and baseline characteristics of up to 12,532 patients were analysed using both complete case and multiply imputed models. Implementation of bundles varied. COPD care bundles were associated with slightly lower secondary care costs, but there was no evidence that they improved outcomes once adjustments were made for site and baseline covariates. Care bundles were unlikely to be cost effective for the NHS with an estimated net monetary benefit per 90-day death avoided from an adjusted multiply imputed model of −£1231 (95% confidence interval − £2428 to − £35) at a high cost-effectiveness threshold of £50,000 per 90-day death avoided. Conclusion and Recommendations Care bundles for COPD did not appear to be cost effective, although this finding may have been influenced by unmeasured variations in bundle implementation and other potential confounding factors.

Suggested Citation

  • Padraig Dixon & William Hollingworth & Jonathan Benger & James Calvert & Melanie Chalder & Anna King & Stephanie MacNeill & Katherine Morton & Emily Sanderson & Sarah Purdy, 2020. "Observational Cost-Effectiveness Analysis Using Routine Data: Admission and Discharge Care Bundles for Patients with Chronic Obstructive Pulmonary Disease," PharmacoEconomics - Open, Springer, vol. 4(4), pages 657-667, December.
  • Handle: RePEc:spr:pharmo:v:4:y:2020:i:4:d:10.1007_s41669-020-00207-w
    DOI: 10.1007/s41669-020-00207-w
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    References listed on IDEAS

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    1. Noémi Kreif & Richard Grieve & M. Zia Sadique, 2013. "Statistical Methods For Cost‐Effectiveness Analyses That Use Observational Data: A Critical Appraisal Tool And Review Of Current Practice," Health Economics, John Wiley & Sons, Ltd., vol. 22(4), pages 486-500, April.
    2. Jeffrey S. Hoch & Andrew H. Briggs & Andrew R. Willan, 2002. "Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 415-430, July.
    3. Rita Faria & Manuel Gomes & David Epstein & Ian White, 2014. "A Guide to Handling Missing Data in Cost-Effectiveness Analysis Conducted Within Randomised Controlled Trials," PharmacoEconomics, Springer, vol. 32(12), pages 1157-1170, December.
    4. Ariel Linden, 2016. "COVBAL: Stata module for producing covariate balance statistics," Statistical Software Components S458188, Boston College Department of Economics, revised 03 Nov 2020.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 21st December 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-12-21 12:00:05

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