Respiratory physiotherapy interventions focused on exercise training and enhancing physical activity levels in people with chronic obstructive pulmonary disease are likely to be cost-effective: a systematic review

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 curricu-
lum 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 consid-
ered 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.