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Management of Chronic Obstructive Pulmonary Disease National Clinical Guideline

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Management of Chronic Obstructive Pulmonary Disease National Clinical Guideline Banner

The National Clinical Effectiveness Committee (NCEC) requires consideration of evidence on both the clinical and cost-effectiveness of health technologies in the development of all National Clinical Guidelines (NCGs) in Ireland. The completion of a budget impact analysis (BIA) based on the NCG’s implementation is also required. The role of the HRB-CICER team is to independently review the evidence and provide scientific and methodological support in the development, by the Guideline Development Group (GDG), of these evidence-based NCGs.
The NCG for Management of Chronic Obstructive Pulmonary Disease (COPD) has been developed to outline the best practice integrated care and services for a person with, or at risk of developing, COPD as they progress through the stages of their condition. To support the development of the NCG, the HRB-CICER team conducted:
1.    A systematic review of cost-effectiveness of the interventions for management of COPD recommended by the NCG 
2.    A BIA to quantify the cost and resource implications to the Health Service Executive (HSE), following implementation of the NCG. 

COPD is a common, preventable and treatable disease characterised by persistent respiratory symptoms and airflow limitation due to airway and or alveolar abnormalities. Although effective management can improve quality of life, COPD is a life-long condition for which no cure currently exists. 
As part of ongoing health system reform in Ireland, an Integrated Care Programme for Prevention and Management of Chronic Disease is being introduced on a phased basis. Under the Programme, community healthcare services will be provided through primary care teams and Community Healthcare Networks (CHNs), with the aim of caring for more people in the community and ensuring better coordination between acute and community care pathways. The budget impact analysis aimed to quantify the cost and resource implications of reorienting some COPD care from acute to community settings as recommended in the NCG. 

Based on the NCG’s recommendations and implementation plan, the resource implications comprise the expanded provision of:

  • 32 additional pulmonary rehabilitation programme (PRP) teams
  • 15 additional COPD outreach teams
  • 32 additional oxygen assessment clinic sites
  • 32 specialist teams to support community diagnostics.

The systematic review of cost-effectiveness was carried out in accordance with agreed HRB-CICER processes and following the HIQA guidelines for the retrieval and interpretation of economic literature.

The BIA was conducted in accordance with the HIQA guidelines for budget impact analysis and economic evaluation in Ireland.