Question
What is the cost-effectiveness of respiratory physiotherapy interventions for people with chronic obstructive pulmonary disease?
Design
Systematic review of full economic evaluations alongside clinical trials published between 1997 and 2021. Reviewers independently screened studies for inclusion, extracted data and assessed methodological quality.
Participants
People with chronic obstructive pulmonary disease.
Intervention
Respiratory physiotherapy interventions as defined in the respiratory physiotherapy curriculum of the European Respiratory Society.
Outcome Measures
Costs expressed in monetary units, effect sizes expressed in terms of disease-specific quality of life (QOL), quality-adjusted life years (QALYs) or monetary units.
Results
This review included 11 randomised trials with 3,261 participants. The interventions were pulmonary rehabilitation, airway clearance techniques, an integrated disease-management program and an early assisted discharge program, including inpatient respiratory physiotherapy. Meta-analysis was considered irrelevant due to the extensive heterogeneity of the reported interventions. A total of 45 incremental cost-effectiveness ratios (ICERs) were extracted. Regardless of the economic perspectives, 67% of all QOL-related ICERs and 71% of all QALY-related ICERs were situated in the north-east or south-east quadrants of the cost-effectiveness plane. Six studies could be seen as cost-effective when compared with a specified cost-effectiveness threshold per QALY gained.
Conclusion
Respiratory physiotherapy interventions focusing on exercise training in combination with enhancing physical activity levels are likely to be cost-effective in terms of costs per unit QOL gained and QALYs. Some uncertainty still exists on the various estimates of cost-effectiveness due to differences in the content and intensity of the type of interventions, outcome measures and comparators.
Registration
PROSPERO CRD42018088699.