A characterisation of the quality of life and healthcare resource use among people with moderate to severe COPD and comorbidities: an economic evaluation alongside the TICC-PCP pilot randomised controlled trial

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Abstract
BackgroundPeople with symptomatic COPD and comorbidities often experience suboptimal prescribing and may be housebound. A tailored, home-based intervention by independent prescriber pharmacists collaborating with consultant physicians (TICC-PCP) may improve outcomes and optimise healthcare resource use. This economic evaluation alongside the TICC-PCP multicentre pilot RCT, assessed the feasibility of collecting healthcare resource use and health-related quality of life (HRQoL) data and characterised these outcomes in this patient population.MethodsThe pilot RCT recruited 110 adults with moderate to severe COPD and comorbidities across two sites in Scotland. Participants were randomised to receive TICC-PCP plus usual care or usual care alone. Healthcare resource use and HRQoL (EQ-5D-5L) data were collected at baseline and at three-month follow-ups over 21 months. Costs were estimated from the NHS perspective (2021 GBP), applying a micro-costing approach.ResultsParticipants were 59% female with a mean age of 67.4 (SD: 8.2) and a mean of 11.5 (SD 6.9) comorbidities. EQ-5D questionnaire completion rates exceeded 90% at follow-ups with baseline mean utility being 0.324 (SD 0.369) and 25.5% of participants reporting utilities less than 0 (considered “worse than death”). Mean annual direct medical cost at baseline was £7,717.86 (SD: £9,163.52), largely driven by inpatient care. The intervention cost averaged £401.25 (SD: £159.87) per participant. Compared with usual care, the intervention showed indicative HRQoL improvement along with increased healthcare costs.ConclusionFindings demonstrate feasibility of health economic data collection and characterise the high disease burden in this population. A definitive RCT is required to determine cost effectiveness.