Cost-utility analysis of transitional care services for older inpatients with chronic obstructive pulmonary disease (COPD) in Korea

초록

BackgroundChronic obstructive pulmonary disease (COPD) is associated with a high readmission rate and poses a significant disease burden. South Korea initiated pilot projects on transitional care services (TCS) to reduce readmissions. However, evidence from cost-effectiveness analyses remains undiscovered. This study aimed to evaluate the cost-effectiveness of TCS in patients with COPD from the healthcare system' perspective.MethodA cost-utility analysis was conducted using a Markov model containing six components of possible medical use after discharge. Transition probabilities and medical costs were extracted from the National Health Insurance Service Senior Cohort (NHIS-SC), and utility data were obtained from published literature. Sensitivity analyses were performed to test the robustness of the results.ResultsConducting TCS produced an incremental quality-adjusted life years gain of 0.231, 0.275, 0.296 for those in their 60s, 70s, and 80s, respectively, and cost savings of $225.16,$1668, and $2251.64forthoseintheir60s,70s,and80s,respectively,perpatientovera10-yeartimehorizon.ThedeterministicsensitivityanalysisindicatedthattheTCScostandthecostofreadmissionbyotherdiseasesimmenselyimpacttheresults.Theprobabilisticsensitivityanalysesshowedthattheprobabilitythattheincrementalcost-effectivenessratioisbelow$23,050 was over 85%, 93%, and 97% for those in the 60s, 70s, and 80s, respectively.ConclusionsTCS was the dominant option compared to usual care. However, it is advantageous to the healthcare budget preferentially consider patients aged over 70 years with severe TCS symptoms. In addition, it is essential to include the management of underlying comorbidities in TCS intervention.Trial registrationClinical Research Information Service (CRIS), KCT0007937. Registered on 24 November 2022

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