It was not too many years ago when almost all self-management programs for respiratory diseases were developed for asthma. This has changed in the past couple of decades with programs being designed and tested for respiratory disorders ranging from bronchiecstasis to chronic obstructive pulmonary disorder (COPD). COPD, in particular, has been the focus of attention in the use self-management. There is evidence, for example, to suggest that disease management with self-management education provided by a case manager might benefit COPD patients. A study by Bourbeau and colleagues sought to determine whether this approach was more cost-effective than usual care by comparing patients provided self-management with those receiving usual care over a 1-year follow-up period. One hundred ninety-one Canadian COPD patients who required hospitalization in the year preceding enrollment were recruited from seven respiratory outpatient clinics. In addition to usual care, patients in the intervention group received standardized education on a COPD self-management program called "Living Well with COPD" with ongoing supervision by a case manager. Costs between the two groups were compared with estimates of the cost per hospitalization prevented.
The additional cost of the self-management program as compared to usual care, $3,778 (2004 Canadian dollars) per patient, exceeded the savings of $3,338 per patient based on the study design with a caseload of 14 patients per case manager. However, through a sensitivity analysis, it was shown that if case managers followed up 50 patients per year, the self-management intervention would be cost saving relative to usual care (cost saving of $2,149 per patient). With more realistic potential caseloads of 50 to 70 patients per case manager, estimated program costs would be $1,326 and $1,016 per prevented hospitalization, respectively.

Comments: The authors concluded that self-management of COPD would produce positive economic benefits with increased patient caseload and rising costs of hospitalization. More patients with COPD are living longer lives. Cost of these extra years for COPD patients should also be factored into any future analysis of economic expenses. In addition, the quality of life of COPD patients can be assessed through a number of reliable and valid paper-and-pencil instruments. Determining that patients who perform self-management skills also maintain a higher quality of life with COPD is also worthy of analysis in the future. Economic values of quality of life can also be calculated.

J. Bourbeau et al. Economic benefits of self-management education in COPD. Chest, 2006; 130:1704-1711.