Pulmonary rehabilitation after COPD hospitalization was associated with lower health care costs and improved quality-adjusted life expectancy, according to a univarite analysis published recently in the Journal of the American Medical Association Network Open.

The nearly 10% of US adults with COPD experience greater morbidity and death, as well as health care costs that are likely to approach $1 trillion in the next 2 decades, research indicates. Past studies have also indicated that pulmonary rehabilitation for patients with COPD (such as education, supervised exercise, modified behavior to improve physical function) is associated with reduced deaths and rehospitalizations in the year following a COPD-related discharge. Researchers sought to evaluate the economic effects of pulmonary rehabilitation following hospitalization for COPD as well as how rehabilitation affected quality-adjusted life expectancy in COPD patients.

Investigators conducted a retrospective microsimulation, univariate analysis, and probabilistic sensitivity analysis, the primary source of data being US Medicare beneficiaries (total number analyzed undisclosed) with COPD from January 2014 through December 2015. Of those individuals analyzed (mean age 76.9 years, range 60-92 years; 58.6% female) microsimulation suggested $5721 net cost savings (95% prediction interval [PI], $3307-$8388) and 0.53 years gained in quality-adjusted life expectancy (95% PI, 0.43-0.63). Univariate analyses of age, number of pulmonary rehabilitation sessions, and the Global Initiative for Obstructive Lung Disease stage showed the same results. Net cost savings and gain in quality-adjusted life expectancy were seen in 100% of the 1000 samples used in probabilistic sensitivity. Given 36 pulmonary rehabilitation sessions, 1-way sensitivity analysis of total cost showed $171 savings per session and incremental cost-effectiveness ratio of $884 per session for $50,000/quality adjusted life-years.

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Researchers concluded that pulmonary rehabilitation following hospitalization for COPD “appeared to result in net cost savings along with improvement in quality-adjusted life expectancy. These findings suggest that stakeholders should identify policies to increase access and adherence to pulmonary rehabilitation for patients with COPD.”

Significant study limitations include the use of data from European studies that may not be generalizable to the US population, use of probabilistic analysis, use of 9 mean pulmonary rehabilitation visits which investigators feel may have underestimated the cost of the full 36 sessions and underestimated the effectiveness, productivity costs were unaccounted for, and results were not validated.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mosher CL, Nanna MG, Jawitz OK, et al. Cost-effectiveness of pulmonary rehabilitation among US adults with chronic obstructive pulmonary disease. JAMA Netw Open. 2022;5(6):e2218189. doi:10.1001/jamanetworkopen.2022.18189

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