Monday, October 19, 2015: 1:30 PM
Grand Ballroom C (Hyatt Regency St. Louis at the Arch)

Austin Nam, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, Aysegul Erman, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada and Murray D Krahn, MD, MSc, FRCPC, Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada
Purpose: Chronic obstructive pulmonary disease (COPD) is the leading cause of healthcare utilization and the fourth leading cause of death in Canada. A growing body of evidence suggests that telehomecare (THC) may be effective in reducing healthcare utilization associated with COPD-related exacerbations. In Canada, telehomecare has been gaining wider acceptance for management of chronic diseases. The objective of this study was to estimate the long-term cost-effectiveness of telehomecare compared to usual care for Canadian COPD patients. 

Method: A state-transition model was used to examine the cost-effectiveness of telehomecare and usual care for a hypothetical cohort of mixed gender 50 year old Canadian COPD patients. The model included health states structured around disease stages according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) classifications. Subgroup analyses were performed for age decile groups (30 to 80 years) and disease severity. A conservative scenario analysis, in which the treatment effect of telehomecare ceased upon patient departure from the telehomecare program (6 months), was conducted to consider the impact of duration of effect on the cost-effectiveness estimate. Model data were obtained from published literature. We used a payer perspective, a lifetime horizon and a 5% discount rate. 

Result: Telehomecare was associated with higher costs ($38,320.01 vs. $36,862.72) and gains QALYs (13.02 vs. 13.00 QALYs) per person, translating to an ICER of $53,336.99/QALY gained compared to usual care.  Subgroup analyses indicated that ICERs were lower for older patients (>60 years) or higher disease severity (> stage 2). In a scenario analysis in which the effect of telehomecare was not sustained beyond the duration of the program (6 months), the model estimated a higher ICER of $84,933.23/QALY gained. 

Conclusion: Our analysis suggested that telehomecare is likely to be cost-effective for 50-year old mixed gender COPD patients at a WTP threshold of $100,000/QALY. Telehomecare may be more cost-effective in older, more severe patients. The duration of telehomecare effects over the cohort’s lifetime may have substantial effects on the cost-effectiveness of the program.