Self-management (SM) support for patients with chronic obstructive pulmonary disease (COPD) is variable in its coverage, content, method and timing of delivery. A paper published by Health Technology Assessment (Jordan RE et al, May 2015) has conducted a systematic review to identify characteristics of the most effective and cost-effective interventions.
The review looked at interventions which began within 6 weeks of hospital discharge, and within those focused on the qualitative evidence about patient satisfaction, acceptance and barriers to SM interventions, the cost effectiveness of SM interventions, and which components of SM interventions impacted on hospital admissions and quality of life.
10 randomised controlled trials were eligible and included within the review. The main limitations result from the heterogeneity of studies available and widespread problems with their design and reporting.
There was little evidence of benefit of providing SM support to patients shortly after discharge from hospital, although effects observed were consistent with possible improvement in health related quality of life and reduction in hospital admissions. It was not easy to tease out the most effective components of SM support packages, although interventions containing exercise seemed the most effective.
A speculative economic model was developed to explore the cost-effectiveness of such an intervention – if it were truly effective at reducing hospital admissions. The main drivers of the model were the effect on hospital readmission, the duration of the effect and the cost of a SM programme. To be cost-effective, a SM programme post admission would need to cost no more than £2200 if there was an 18% reduction in readmissions. The sensitivity analysis suggested that SM had a probability of 68% of being cost-effective at a threshold incremental cost-effectiveness ratio of £20,000 per quality-adjusted life-year, demonstrating the uncertainty around the impact of SM on readmissions.
The study included recommendations for future research to further understanding of the impact of SM interventions.
The full study can be read here.
Jordan RE, Majothi S, Heneghan NR, Blissett DB, Riley RD, Sitch AJ, et al.Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis. Health Technol Assess 2015;19(36)