A Social Return on Investment Analysis of Improving the Management of Chronic Obstructive Pulmonary Disease Within the Spanish National Healthcare System

Abstract

María Merino,1 Teresa Martín Lorenzo,1 Paulina Maravilla-Herrera,1 Julio Ancochea,2– 4 José Tomás Gómez Sáenz,5 Nicole Hass,6 Jesús Molina,7 Germán Peces-Barba,8 Marta Trapero-Bertran,9 Juan Antonio Trigueros Carrero,10 Álvaro Hidalgo-Vega11 1Health Outcomes Research, Weber, Madrid, Spain; 2Pulmonology Service, La Princesa University Hospital - IIS-Princesa, Madrid, Spain; 3Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; 4Respiratory Diseases Networking Biomedical Research Centre - CIBERES, Carlos III Institute of Health - ISCIII, Madrid, Spain; 5Nájera Health Centre, Nájera, La Rioja, Spain; 6Chronic Obstructive Pulmonary Disease Patient and Family Association - APEPOC, Pontevedra, Spain; 7Francia Health Centre, Fuenlabrada, Madrid, Spain; 8Pulmonology Service, Fundación Jiménez Díaz University Hospital, Madrid, Spain; 9Basic Sciences Department, University Institute for Patient Care, Universitat Internacional de Catalunya, Barcelona, Spain; 10Menasalbas Health Centre, Mensalbas, Toledo, Spain; 11Department of Economic Analysis and Finances, Universidad de Castilla-La Mancha, Toledo, SpainCorrespondence: María Merino, Health Outcomes Research, Weber, Calle Moreto 17, 5° Dcha, Madrid, 28014, Spain, Tel [phone], Fax [phone], Email [email protected]: To define a set of proposals that would improve the current management of chronic obstructive pulmonary disease (COPD) within the Spanish National Healthcare System (SNHS) from a comprehensive multidisciplinary perspective and to assess the impact of its implementation from clinical, healthcare, economic, and social perspectives.Patients and Methods: A group of 20 stakeholders related to COPD (healthcare professionals, patients, and informal caregivers, among others) participated in an online Delphi process to agree on a set of 15 proposals that would improve the current management of COPD within the SNHS in four areas: diagnosis, risk stratification, management of exacerbations, and management of stable COPD. A one-year forecast-type social return on investment (SROI) analysis was used to estimate the impact that implementing the set of proposals would have in relation to the investment required. A sensitivity analysis was used to test the strength of the model when varying assumption-based data-points.Results: The hypothetical implementation of the complete set of 15 proposals would require a € 668 million investment and would generate a € 2079 million social impact concerning savings for the SNHS and quality of life improvements for patients and their informal caregivers, among others. Accordingly, for every euro invested in the set of proposals, a social return of € 3.11 would be generated (€ 2.71 in the worst-case scenario and € 3.62 in the best-case scenario) of both tangible (32.56%) and intangible nature (67.44%).Conclusion: Altogether, implementing this set of 15 proposals would generate a positive social impact, threefold the required investment. The results may inform decisions relative to healthcare policy and practice regarding COPD management within the SNHS, further contributing to reduce the large burden of COPD.Keywords: disease management, chronic disease, respiratory disease, economic evaluation, social impact, Spain

Keywords

• disease management
• chronic disease
• respiratory disease
• economic evaluation
• social impact
• spain