Better Breathlessness Services for Older People with Advanced Diseases: A Multicentre Discrete Choice Experiment and Economic Modelling (OPRBreathe)

Background: In advanced respiratory disease, breathlessness becomes severe, increasing health services use. Breathlessness Services (BSs) demonstrate effectiveness in trials and meta-analyses but lack health economic assessment and modelling of their impacts on care services. Methods: We conducted a discrete choice experiment (DCE), followed by cost-effectiveness analysis modelling. The DCE comprised face to face interviews with older patients with chronic breathlessness and their carers across eight UK centres. Regression analysis of DCE data determined the preferences (or not, indicated by negative β coefficients) of service attributes for patients. Economic modelling estimated costs and quality adjusted life years (QALYs) over five years. Findings: We recruited 190 patients, 68 carers. Offering BSs from GP surgeries was not preferred (β =-0.30, 95% CI -0.40 to -0.21); hospital outpatient clinics (0.16, 0.06 to 0.25) or via home visits (0.15, 0.06 to 0.24) were preferred. BSs with comprehensive treatment review (0.15, 0.07 to 0.21) and holistic support (0.19, 0.07 to 0.31) were preferred to usual services. Cost-effectiveness analysis found the most and the least preferred models of BSs were cost-effective compared to usual care. The most preferred BSs had £5,719 lower costs and 0.004 QALY benefit per patient. Uptake was higher when attributes were tailored to individual preferences (86% versus 40%). Interpretation: BSs are cost-effective compared to usual care for health and social care, giving cost savings and better quality of life. Uptake of BSs is higher when service attributes are individually tailored. Funding: This study was funding by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0815-20026). Declaration of Interest: All authors have nothing to disclose. Ethical Approval: This study received ethical approval from the West of Scotland Research Ethics Service (Ref. 17/WS/0083).