Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme

Background-Pulmonary rehabilitation programmes improve the health of patien ts disabled by lung disease but their cost effectiveness is unproved. We un dertook a cost/utility analysis in conjunction with a randomised controlled clinical trial of pulmonary rehabilitation versus standard care. Methods-Two hundred patients, mainly with chronic obstructive pulmonary dis ease, were randomly assigned to either an 18 visit, 6 week rehabilitation p rogramme or standard medical management. The difference between the mean co st of 12 months of care for patients in the rehabilitation and control grou ps (incremental cost) and the difference between the two groups in quality adjusted life years (QALYs) gained (incremental utility) were determined. T he ratio between incremental cost and utility (incremental cost/utility rat io) was calculated. Results-Each rehabilitation programme for up to 20 patients cost pound 12 1 20. The mean incremental cost of adding rehabilitation to standard care was pound -152 (95% CI -881 to 577) per patient, p=NS. The incremental utility of adding rehabilitation was 0.030 (95% CI 0.002 to 0.058) QALYs per patie nt, p=0.03. The point estimate of the incremental cost/utility ratio was th erefore negative. The bootstrapping technique was used to model the distrib ution of cost/utility estimates possible from the data. A high likelihood o f generating QALYs at negative or relatively low cost was indicated. The pr obability of the cost per QALY generated being below pound0 was 0.64. Conclusions-This outpatient pulmonary rehabilitation programme produces cos t per QALY ratios within bounds considered to be cost effective and is like ly to result in financial benefits to the health service.