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Seidl, H. ; Schunk, M.* ; Le, L.* ; Syunyaeva, Z.* ; Streitwieser, S.* ; Berger, U.* ; Mansmann, U.* ; Szentes, B.L. ; Bausewein, C.* ; Schwarzkopf, L.

Cost-effectiveness of a specialized breathlessness service versus usual care for patients with advanced diseases.

Value Health 26, 81-90 (2023)
Publ. Version/Full Text DOI PMC
Open Access Green as soon as Postprint is submitted to ZB.
OBJECTIVES: The Munich Breathlessness Service (MBS) significantly improved control of breathlessness measured by the Chronic Respiratory Questionnaire (CRQ) Mastery in a randomized controlled fast track trial with waitlist group design spanning 8 weeks in Germany. This study aimed to assess the within-trial cost-effectiveness of MBS from a societal perspective. METHODS: Data included generic (5-level version of EQ-5D) health-related quality of life and disease-specific CRQ Mastery. Quality-adjusted life years (QALYs) were calculated based on 5-level version of EQ-5D utilities valued with German time trade-off. Direct medical costs and productivity loss were calculated based on standardized unit costs. Incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves were calculated using adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) and performing 1000 simultaneous bootstrap replications. Potential gender differences were investigated in stratified analyses. RESULTS: Between March 2014 and April 2019, 183 eligible patients were enrolled. MBS intervention demonstrated significantly better effects regarding generic (AMD of QALY gains of 0.004, 95% confidence interval [CI] 0.0003 to 0.008) and disease-specific health-related quality of life at nonsignificantly higher costs (AMD of €605 [95% CI -1109 to 2550]). At the end of the intervention, the ICER was €152 433/QALY (95% CI -453 545 to 1 625 903) and €1548/CRQ Mastery point (95% CI -3093 to 10 168). Intervention costs were on average €357 (SD = 132). Gender-specific analyses displayed dominance for MBS in males and higher effects coupled with significantly higher costs in females. CONCLUSIONS: Our results show a high ICER for MBS. Considering dominance for MBS in males, implementing MBS on approval within the German health care system should be considered.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Breathlessness Service ; Cost-effectiveness Analysis ; Disease-specific Health-related Quality Of Life ; Gender Specific ; Generic Health-related Quality Of Life ; Multidisciplinary Nonmedical Intervention ; Palliative Medicine; Chronic Respiratory Questionnaire; Palliative Care; Health-care; Refractory Breathlessness; Terminally-ill; Perspective; Outcomes; Qalys; Home; Age
ISSN (print) / ISBN 1098-3015
e-ISSN 1524-4733
Journal Value in Health
Quellenangaben Volume: 26, Issue: 1, Pages: 81-90 Article Number: , Supplement: ,
Publisher Elsevier
Publishing Place New York, NY
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Health Economics and Health Care Management (IGM)
Grants Bundesministerium für Bildung und Forschung