Culturally adapted pulmonary rehabilitation for people with post-tuberculosis lung disease in Kyrgyzstan: a randomised controlled trial of clinical and cost-effectiveness

<bold>Background:</bold> Despite completing treatment, many tuberculosis survivors suffer post-tuberculosis lung disease (PTLD), reducing their quality of life, compounded by social stigma. We conducted the first full-powered randomised controlled trial (RCT) of culturally adapted pulmonary rehabilitation (PR) in Kyrgyzstan. <bold>Methods:</bold> An assessor-blind RCT compared culturally adapted PR with usual care. Primary outcome was maximal exercise capacity, measured by incremental shuttle walking test (ISWT) from baseline to the end of 6-week PR. Health-related quality of life was evaluated using EQ5D5L visual analogue scale (VAS). The EQ5D5L was utilised to map to quality-adjusted life years (QALYs) and to calculate the PR cost/QALY gained. <bold>Results:</bold> 114 patients (aged 45±16 years, 52% male) were randomised (n=61 PR and n=53 control). 58 participants in PR (95%) attended 12/12 PR classes. Change in ISWT for the intervention group exceeded the MCID of 35m (117m [95%CI 86-148] p<0.001) with a significant improvement compared to the control group (123m [95%CI 121-125] p<0.001). Change in VAS for the intervention group exceeded the MCID of 7 (17.9 [95%CI 14.4-21.3] p<0.001) with a significant improvement compared to the control group (20.2 [95%CI 19.9-20.4] p<0.001). Post PR, treatment group QALY scores increased, resulting in a statistically significant difference in difference between the treatment and control group (0.15 [95%CI 0.12-0.19] p<0.001). This implies an average cost of PR of US$614.10/QALY [95%CI 464.70-763.49]. <bold>Conclusion:</bold> Culturally-adapted PR was clinically and cost-effective for people with PTLD in Kyrgyzstan.