The objectives of this assessment were to evaluate the effect of PR programs for COPD on clinical and economic outcomes, and to assess their health services impact. The research questions were: ? What is the clinical effectiveness of PR and pharmacotherapy (together) compared with pharmacotherapy alone for adults with COPD? ? What is the effectiveness of specific elements of PR programs for adults with COPD? ? What is the cost-effectiveness of PR and pharmacotherapy compared with pharmacological therapy alone in adults with COPD? What is the health services impact of implementing PR for adults with COPD in Canada? ? What are the recommendations for the use of PR in current COPD clinical practice guidelines that are relevant to the Canadian context? The studies that are included in this review showed that, when compared with the usual care (pharmacotherapy) of patients with stable COPD, PR plus usual care is effective in the short term (up to three months), as indicated by improvement in exercise capacity, health-related quality of life (HRQL), and mental health. In some studies, however, the improvements in outcomes were below the minimal clinically important differences. Some longer-term studies found that the benefits from the use of PR disappeared in 12 months or less. Others found that the benefits were sustained for two to three years. Reductions in health care utilization, as indicated by the number of hospital admissions or the length of stay, were reported in studies of variable quality. The findings suggested that patients with COPD can benefit from the use of PR regardless of age, sex, and disease severity. Home-based PR programs provided similar benefits to those obtained from hospital outpatient PR programs. The appropriate duration and content of PR programs is unclear. Information on comparisons of PR with other treatments and on the effectiveness of components of PR programs was limited. Four clinical practice guidelines were identified as being relevant to Canada. Common themes included support for the use of PR for patients with COPD who have dyspnea and reduced exercise capacity, and the inclusion of education as a component of PR. If the duration of efficacy of PR is 18 months, the incremental cost-effectiveness ratio of usual care plus PR compared with usual care is $27,924 per additional quality-adjusted life-year (QALY) gained.Â If it is assumed that only the moderate and severe cases need PR, then 1,505 additional persons would be served annually in Canada over a ten-year period for an added annual cost of $1.8 million. If 25% of persons with COPD need PR, this cost would rise to $33.9 million annually for 100% uptake or $19 million if 67% of those who are in need used the services. If all persons with COPD needed PR, the additional annual cost would be $168 million.
The use of PR improves short-term exercise capacity, HRQL, and mental health outcomes for patients with COPD. More work is needed to confirm the factors that contribute to the successful long-term management of COPD after PR. There is limited information on the effectiven
Hailey D, Jacobs P, Stickland M, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease: clinical, economic, and budget impact analysis. Canadian Agency for Drugs and Technologies in Health (CADTH). 2010 Mar;126:1-155