Table 2.

Cost parameters used in the company’s model and any changes made by the EAG [1]

Parameter	Company	EAG	Source
Model 1 AECOPD
Technology costs (per registered patient)	£0.25 pa	No change	Company submission
Exacerbation self-managed or managed in primary care	£53.59	£81.75	Adapted from Jordan et al., 2015 [34]. EAG updated with 2019/2020 reference costs [35]
Emergency hospital admission for AECOPD	£1583	£1721	COPD PRIME [30] (updated with reference costs 2018/2019 [36]). EAG updated with 2019/2020 reference costs [35]
GP appointment (9.2 mins)	£39	No change	PSSRU 2020 [37]
Practice nurse per hour (band 5) to register patients and train	£39	No change	PSSRU 2020 [37]
Practice manager to administer top-level licences	£48	No change	PSSRU 2020 [37]
CCG licence set-up	£360	No change	7.5 h of a practice manager’s time at £48 an hour (PSSRU 2020 [37] and company assumption)
Training of one clinician per CCG to use myCOPD	£1950	No change	QOF data give an average of 50 GP practices per CCG. Company: PSSRU 2020 [37] Training given by a band 5 practice nurse [36, 37]
Patient myCOPD licence registration (per year)	£9.75	£19.50	Company submission: 15 min to register a patient by a band 5 practice nurse [37]. Clinical experts queried by the EAG gave a range of between 15 and 45 min, and potentially by band 6 or 7 staff. The EAG judged it appropriate to be conservative and assume 30 min for the base-case value, with a range of 15 (band 5) to 45 min (band 6) used in sensitivity analysis
Model 2 PR
Annual cost of myCOPD per patient (PR service costing scenario only)	£10,000	No change	Provided by the company
Cost to administer licences (PR service costing scenario only)	£360	No change	Practice manager assumed to administer top-level licences at a cost of £48 per hour [37]). Assumed to take 1 day
Cost of training for a PR service to use myCOPD (PR service costing scenario only)	£195	No change	Assumed to be five band 5 staff trained for 1 h each to reflect the PR service being delivered more centrally. Costed using PSSRU 2020 [37]
Face-to-face PR programme	£695	No change	COPD PRIME (updated using PSSRU 2020 staff costs [37]). Assumed to include the cost of initial and post-discharge assessment
Face-to-face PR assessment	£79	No change	PSSRU 2020 [37], expert opinion – 1 h of band 6 and 1 h of band 4. The same cost was applied for initial assessment and post-discharge assessment
Cost per exacerbation	£283	£328	15% probability of exacerbation being treated in hospital (COPD PRIME [30]) multiplied by the cost of a hospital admission for exacerbation. 85% probability of exacerbation being treated in primary care multiplied by the cost of a non-admitted exacerbation. Costs of admitted and non-admitted exacerbation as per the AECOPD model
Telephone support for remote PR (myCOPD only)	£18	No change	Expert opinion three 10-min phone calls. Assumed to be a band 6 community therapist at a cost of £49 per hour (PSSRU 2020 [37])
Cost to register a patient for a myCOPD licence	£9.75	£19.50	Company submission assumed 15 min of band 5 practice nurse time at a cost of £39 per hour [37]). Clinical experts queried by the EAG gave a range of between 15 and 45 min, and potentially by band 6 or 7 staff. The EAG judged it appropriate to be conservative and assume 30 min for the base-case value, with a range of 15 (band 5) to 45 min (band 6) used in sensitivity analysis
Cost of time waiting for assessment	£33	£39	Company: Cost per exacerbation (as above) multiplied by a total waiting time of 13 days multiplied by the annual number of exacerbations in people who did not complete PR (3.31)
Cost of starting and not finishing PR: face-to-face PR	–	£26	Assumed to be the cost of face-to-face PR minus assessment costs, divided by 6. Reflects the cost of patients attending one session before dropping out. Applied to 29% of patients (based on the COPD PRIME tool, which states 59% of those referred start PR, and of those starting, 71% complete their PR programme [37])
Cost of starting and not finishing PR: Hybrid	–	£13	Assumed to be the cost of starting and not finishing face-to-face PR halved
Cost of starting and not finishing PR: myCOPD	–	£2	Assumed to be the cost of one support phone call [37] Proportion starting but not finishing PR was assumed to be the same as face-to-face PR

AECOPD acute exacerbations of chronic obstructive pulmonary disease, CCG clinical commissioning group, COPD chronic obstructive pulmonary disease, EAG External Assessment Group, GP general practitioner, PR pulmonary rehabilitation, PSSRU Personal Social Services Research Unit, QOF quality and outcomes framework