Pulmonary rehabilitation is an important evidenced-based treatment to improve health and quality of life for people living with Chronic Obstructive Pulmonary Disease (COPD).
Now, new research from the Duke Clinical Research Institute has shown that the benefits of pulmonary rehabilitation are likely to extend beyond the patient to reduce costs for the health care system as well – with an estimated savings of more than $5,000 per patient.
“Cost-effectiveness of Pulmonary Rehabilitation Among U.S. Adults With Chronic Obstructive Pulmonary Disease,” an original investigation published in JAMA Network Open, examined potential cost savings among a hypothetical cohort of COPD patients who participated in pulmonary rehabilitation. Researchers found that participating in pulmonary rehabilitation would result in a net savings of $5,721 per patient, along with extensive health and wellness benefits to the patients that have been noted in previous studies.
The researchers hope that by showing the cost savings resulting from pulmonary rehabilitation, payers will further incentivize patients to participate, and reduce barriers that may dissuade patients, such as copayments and transportation costs.
“Our findings can be used by payers to justify novel strategies that promote more wide use of pulmonary rehab on the basis of future cost savings to the payer,” said Christopher L. Mosher, MD, MHS, first author of the study and a DCRI pulmonology faculty member. “Based on previously identified barriers to participation, future cost savings could be allocated toward increasing pulmonary rehab reimbursement and providing or subsidizing the cost of transportation and visit co-pays.”
The cost-effectiveness of pulmonary rehabilitation has been demonstrated in studies outside of the U.S., but this is the first study of its kind to examine the cost effects within the U.S. health care system.
Pulmonary rehab is a multidisciplinary program where a patient typically works with a variety of health care providers including a physical therapist, a respiratory therapist, and sometimes a pharmacist and nutritionist. The program addresses an array of components, often including medication management and adherence, diet and nutrition, coping with symptoms, and smoking cessation. Mosher added that the foundation of any pulmonary rehab program is the individualized, structured exercise training that the patients receive, and camaraderie brought about by the group sessions.
“The message has been very clear: pulmonary rehab helps patients breathe more easily, improves their quality of life, and allows them to get back to activities they enjoy” Mosher said. “It has even been shown to reduce COPD hospitalization and improve survival at one year, which historically have been hard endpoints to modify in this population.”
“Despite these known benefits, the participation in pulmonary rehab in the United States is abysmal – at less than 5%. In thinking about ways to encourage stakeholders, specifically payers, to think about how to facilitate increased participation in rehab, we thought that investigating the benefits from a cost perspective would be informative.”
In addition to costs assumed by health plans, costs to the patient are not insignificant – particularly because of the number of pulmonary rehab sessions in each program. In this study, researchers assumed an average number of visits per patient informed from the literature. Even with health insurance, patients are still responsible for copayments and the cost of transportation to and from the appointments.
“We hope our findings that estimate pulmonary rehab is not only cost effective, but cost saving will encourage stakeholders to develop novel ways to increase participation that will benefit both the patient and payer,” Mosher said. “We’ve known pulmonary rehab improves the health of patients living with COPD. Now we estimate it also saves the health system money. We are hopeful this will spur meaningful change in health policy as it seems like a win-win.”