The clinical and cost impact of adherence to chronic obstructive pulmonary disease guideline recommendations in England- a cost consequence model

Vioix H, Wright A, de Silva S, Langham S, Gayle A, Soto J, Cook J, Capstick T, Quint J. PRS18 The clinical and cost impact of adherence to chronic obstructive pulmonary disease guideline recommendations in England- a cost consequence model. Value Health 2020;23(Suppl 2):S719

Abstract

Objectives: The objective of this study was to model the clinical and economic impact of adapting current clinical practice in the management of patients with chronic obstructive pulmonary disease (COPD) to treatment according to national and international guideline recommendations.

Methods: A cost-consequence model was developed that uses a treatment-mapping matrix to hypothetically redistribute patients with COPD undergoing long-acting inhaler therapy from their current treatment pathway (actual prescribing patterns) to an alternative treatment pathway that aligns with the National Institute of Health and Care Excellence (NICE) or Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. Actual prescribing patterns were derived using data from the Clinical Practice Research Datalink. The clinical outcomes and costs associated with the alternative pathway over a one year time horizon were estimated from published English sources.

Results Compared with actual prescribing patterns, treatment according to recommendations results in a estimated annual reduction in expenditure of £47 million (NICE) and £43.5 million (GOLD); this is equivalent to an ~8% saving. Considerable savings arose from a reduction in pneumonia cases and associated treatment costs. If patients are treated according to either NICE or GOLD recommendations, there were potential savings of £240 thousand (10%) for mild/moderate pneumonia and £15 million (18%) for severe pneumonia. Due to the redistribution of patients with low prior exacerbations or milder symptoms from triple therapy to other long acting inhaler therapies, there was a potential minimal increase in costs associated with exacerbations (~1%).

Conclusion: Compared with current clinical practice in England, treating patients with COPD according to national and international recommendations may improve patient outcomes and reduce the financial burden on the healthcare system. In addition, given the COVID-19 related impact on the NHS, benefits of reduced hospitalization could be realized by following COPD treatment guidelines.