Transitional care services are cost-effective for older patients with chronic obstructive pulmonary disease in Korea

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BACKGROUND: Transitional care services (TCS) may reduce post-discharge readmissions and improve disease management in patients with chronic obstructive pulmonary disease (COPD). This study evaluated the cost-effectiveness of TCS using state-specific relative risks (RRs) derived from a randomised controlled trial (RCT). METHODS: Between September 2022 and September 2024, 417 patients with COPD discharged from three university hospitals in South Korea were assigned to TCS (n = 210) or usual care (n = 207). State-specific RRs were derived from 3-month RCT outcomes and incorporated into a Markov model with 3-month cycles and a 10-year time horizon. Costs and quality-adjusted life-years (QALYs) were estimated for patients in their 60s, 70s, and 80s. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed to assess parameter uncertainty. RESULTS: In the base-case analysis, TCS increased costs by USD 2,128.91 and USD 1,133.41 per patient in the 60s and 70s cohorts, respectively, but reduced costs by USD 58.01 in the 80s cohort. Incremental QALYs were 0.155, 0.195, and 0.271, respectively. The corresponding incremental cost-utility ratios were USD 13,709.60/QALY and USD 5,816.85/QALY in the 60s and 70s cohorts, while TCS was dominant in the 80s cohort. DSA identified the RR of respiratory-disease readmission as the largest driver of uncertainty, followed by the RR of COPD readmission; the RR of other-disease readmission and TCS intervention cost were also influential. At a willingness-to-pay threshold of USD 23,050/QALY, the probabilities that TCS was cost-effective were 55.7%, 67.9%, and 82.7% for the 60s, 70s, and 80s cohorts, respectively. CONCLUSIONS: This study evaluated the cost-effectiveness of TCS for patients with COPD using state-specific RRs derived from an RCT. TCS was cost-effective across all age cohorts, with more favorable economic outcomes observed in older patients and dominance in the 80s cohort. These findings support the implementation of TCS for patients with COPD, while further research is needed to confirm its long-term clinical and economic benefits.

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