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Cost-Effectiveness of a Specialized Breathlessness Service Versus Usual Care for Patients with Advanced Diseases

Hildegard Seidl,Michaela Schunk, Lien Le,Zulfiya Syunyaeva, Sabine Streitwieser, Ursula Berger,Ulrich Mansmann, Boglarka Lilla Szentes, Claudia Bausewein, Larissa Schwarzkopf

Value in health(2023)

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Abstract
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 signifi-cantly 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 euro 605 [95% CI-1109 to 2550]). At the end of the intervention, the ICER was euro 152 433/QALY (95% CI-453545 to 1625903) and euro 1548/CRQ Mastery point (95% CI-3093 to 10168). Intervention costs were on average euro 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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Key words
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
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