Telerehabilitation Compared with Center-Based Pulmonary Rehabilitation for People with Chronic Respiratory Disease: Economic Analysis of a Randomized Controlled Clinical Trial

<b>Rationale:</b> New pulmonary rehabilitation models can improve access to this effective but underused treatment for people with chronic respiratory disease; however, cost-effectiveness has not been determined. <b>Objectives:</b> To compare the cost-effectiveness of telerehabilitation, including videoconferencing and synchronous supervision, with standard center-based pulmonary rehabilitation. <b>Methods:</b> Prospective economic analyses were undertaken from a societal perspective alongside a randomized controlled equivalence trial in which adults with stable chronic respiratory disease undertook an 8-week outpatient center-based program or telerehabilitation. Clinical assessment for effectiveness (Chronic Respiratory Disease Questionnaire dyspnea domain score) was undertaken at baseline, after pulmonary rehabilitation, and at 12-month follow-up. Individual-level administrative and self-report healthcare cost data were collected over 12 months after the program (Australian dollars, 2020). <b>Results:</b> There were no between-group differences for effectiveness (Chronic Respiratory Disease Questionnaire dyspnea domain mean difference, -0.2 [standard error, 1.0]; <i>P</i> = 0.61) or total costs ($565 [5,452]; <i>P</i> = 0.92) over 12 months. On the cost-effectiveness plane, 97.4% of estimates fell between the equivalence margins for effectiveness. Application of a range of values for cost margin demonstrated a 95% probability that telerehabilitation was equivalent to center-based pulmonary rehabilitation when the threshold was $11,000. The results were robust to approach and sensitivity and subgroup analyses. The internal rate of return was 134% over 5 years. Program completion (regardless of model) was associated with a significant reduction in total costs in the following 12 months (β, -$17,960; 95% confidence interval, -29,967 to -5,952). <b>Conclusions:</b> This study supports delivery of telerehabilitation as a cost-effective alternative model of pulmonary rehabilitation for people with chronic respiratory disease. Clinical trial registered with the Australian and New Zealand Clinical Trials Register (ACTRN12616000360415).