The data envelopment analysis as a model to evaluate the cost- utility study of a pulmonary rehabilitation programme for COPD patients in a university hospital in an European region

Background. The efficiency of pulmonary rehabilitation (PR) programs in patients with COPD, as evaluated through cost-effectiveness analysis (CEA), yields mixed results. The aim of this study is to determine whether the efficiency demonstrated by a PR program using CEA is maintained when applying Data Envelopment Analysis (DEA), a tool used to develop an efficiency frontier for a given intervention. Methods . The profitability of this program was assessed based on its impact on the number of exacerbations and quality of life. The DEA model evaluates a given performance by taking into account all inputs and outputs simultaneously. The inputs were healthcare costs, and the outputs included the number of hospital admissions, hospital stays, ICU stays, emergency department visits, and quality of life (EuroQol-5D). Results . The DEA considers that implementing the PR program is efficient compared to not implementing it, which is deemed inefficient. Furthermore, it estimates the extent to which the inefficient option would need to improve its outcomes (outputs) in order to become efficient: QALYs, 114%; emergency department visits, 252%; ICU, 902%; hospitalizations, 289%; pharmacy, 260%; outpatient visits, 97%. Conclusions . DEA shows that implementing a PR program in patients with COPD is more efficient than not doing so. Moreover, it estimates to what extent the inefficient option would need to improve its outcomes in order to become efficient. However, CEA allows the financial investment to be related to health outcomes, usually measured in QALYs. Healthcare managers should use both methods in a complementary way when assessing the efficiency of a specific intervention before implementing it in clinical practice.