Costs and effectiveness of a disease management program for chronic obstructive pulmonary disease

Introduction The effect of disease management for COPD is not well established Objectives The effect of integrated care intervention (ICI) on hospital admission was examined and a cost analysis was performed Methods 208 COPD patients recruited by general practitioners in Massa-Carrara sanitary district from January 2009 were followed up prospectively. Interventions included individually tailored care plan following GOLD guidelines, educational program on self-management of the disease, treatment supervision during scheduled visits, home visits and phone contacts by specialised nurses. Results Data from the 2-year follow-up were compared with the year prior to its initiation. ICI decreased the frequency of hospitalization and the mean number of hospitalization days in 1-year follow-up period; these results remained stable after 2 years (table 1). The best clinical results were detected in GOLD 2 and 3 stages. Mean daily cost of pulmonary drugs increased (€ 3.1/patient/year vs € 1.3 in the pre-enrolment year), while mean daily cost of hospitalization decreased from € 5.1/patient/year to € 2.2 (p Conclusions The study shows that a standardised ICI based on share-care intervention between primary care and hospital team in COPD patients effectively decreases hospitalizations for exacerbation and total disease costs after 1 year follow-up; these positive results do not change after 2 years.