Résumé
Chronic Obstructive Pulmonary Disease (COPD) is a major cause of healthcare system use and related cost. While pulmonary rehabilitation (PR) is efficient, maintenance programs (PR-MA) can maintain the benefits over time. Yet, the long-term impact (>36 months) of PR-MA on healthcare resource and cost has never been assessed. Recently, a PR-MA program based on self-help associations has shown a clinical efficacy beyond 36 months, Thus, we aimed to assess the effect of this PR-MA program on long-term hospitalizations and costs versus usual care (PR-UC).
We performed an ancillary analysis of the post-rehabilitation LTAir+R cohort study, which compared a PR-MA group (n=144) to a matched PR-UC group (n=137) of COPD patients. Data were collected in 82 PR-MA and 93 PR-UC patients, from the Montpellier University Hospital database and patient records over 60 months, including hospitalizations, consultations, emergency visits, and associated costs.
In PR-AM vs. PR-UC group, the hospitalization probability reduction almost reached significance (hazard ratio: 1.68; p=0.05). The costs of each hospitalization day (867±116 vs. 1213±138 euros/day; p<0.05), emergency visits (8±5 euros/year vs. 12±3 euros/year) and medical consultations (110±3 vs. 174±3 euros/year; p<0.01) were significantly lower in the PR-AM vs. PR-UC group. Last, PR-MA mitigated the increase in total hospitalizations (p<0.001) associated with the follow-up duration.
In addition to its long-term clinical efficacy, this PR-MA program showed a positive impact on hospitalization and healthcare use costs. The effect on hospitalization number and costs could be larger in patients with the longest PR-MA adherence.