Excessive costs of COPD in ever-smokers. A longitudinal community study.
ABSTRACT We aimed to estimate the societal treatment-related costs of COPD in hospital- and population-based subjects with spirometry defined COPD, relative to a control group.
81 COPD cases and 132 controls without COPD were randomly recruited from a general population, as were 205 COPD patients from a hospital register. All participants were ever-smokers of at least 40 years of age, followed for 12 months. Data on comorbid conditions and spirometry were collected at baseline. Standardized telephone interviews every third month gave information on use of healthcare services and exacerbations of respiratory symptoms.
The increased (excessive) median annual costs per case having stage II, stage III and stage IV COPD were € (95% CI) 400 (105-695), 1918 (1268-2569) and 1870 (1031-2709), respectively, compared to the population-based controls. Costs increased with €81 (95% CI 50-112) per exacerbation of respiratory symptoms and €461 (95% CI 354-567) per comorbid condition. Excessive costs for hospital COPD patients were threefold that of the population-based COPD cases.
The excessive treatment-related cost of COPD stage II+ in ever-smokers of at least 40 years was estimated to €105 million for Norway. Comorbidity was a dominant predictor of excessive cost in COPD.
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ABSTRACT: Assess the cost effectiveness of budesonide/formoterol (BUD/FORM) Turbuhaler(®)+tiotropium (TIO) HandiHaler(®) vs. placebo (PBO)+TIO in patients with chronic obstructive pulmonary disease (COPD) eligible for inhaled corticosteroids/long-acting β2-agonists (ICS/LABA). The cost-effectiveness analysis was based on the 12-week, randomised, double-blind CLIMB trial. The study included 659 patients with pre-bronchodilator forced expiratory volume in 1 s ≤ 50% and ≥1 exacerbation requiring systemic glucocorticosteroids or antibiotics the preceding year. Patients received BUD/FORM 320/9 μg bid + TIO 18 μg qd or PBO bid + TIO 18 μg qd. Effectiveness was defined as the number of severe exacerbations (hospitalisation/emergency room visit/systemic glucocorticosteroids) avoided. A sub-analysis included antibiotics in the definition of an exacerbation. Resource use from CLIMB was combined with Danish (DKK), Finnish (€), Norwegian (NOK) and Swedish (SEK) unit costs (2010). The incremental cost-effectiveness ratios (ICERs) for BUD/FORM + TIO vs. PBO + TIO were estimated using descriptive statistics and uncertainty around estimates using bootstrapping. Analyses were conducted from the societal and healthcare perspectives in Denmark, Finland, Norway and Sweden. From a societal perspective, the ICER was estimated at €174/severe exacerbation avoided in Finland while BUD/FORM + TIO was dominant in the other countries. From the healthcare perspective, ICERs were DKK 1580 (€212), €307 and SEK 1573 (€165) per severe exacerbation avoided for Denmark, Finland and Sweden, respectively, while BUD/FORM + TIO was dominant in Norway. Including antibiotics decreased ICERs by 8-15%. Sensitivity analyses showed that results were overall robust. BUD/FORM + TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries. (ClinicalTrials.gov Identifier: NCT00496470).Respiratory medicine 07/2013; · 2.33 Impact Factor
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ABSTRACT: The aim of this study was to describe the impact of COPD on health status in the Burden of Obstructive Lung Disease (BOLD) populations.We conducted a cross-sectional, general population-based survey in 11,985 subjects from 17 countries. We measured spirometric lung function and assessed health status using the short form 12 questionnaire (SF 12). The physical (PCS) and mental health (MCS) component scores were calculated.Subjects with COPD (post-bronchodilator FEV1/FVC<0.70, n=2269) had lower PCS (44±10 vs. 48±10 units, p<0.0001) and MCS (51±10 vs. 52±10 units, p=0.005) than subjects without COPD. The effect of reported heart disease, hypertension, and diabetes on PCS (-3 to -4 units) was considerably less than the effect of COPD GOLD grade 3 (-8 units) or 4 (-11 units). Dyspnoea was the most important determinant of a low PCS and MCS. In addition, lower FEV1, chronic cough, chronic phlegm and the presence of comorbidities were all associated with a lower PCS.COPD is associated with poorer health status but the effect is stronger on the physical than the mental aspects of health status. Severe COPD has a greater negative impact on health status than self-reported cardiovascular disease and diabetes.European Respiratory Journal 05/2013; · 6.36 Impact Factor
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ABSTRACT: The objectives of the presented study were to estimate societal costs of COPD in Sweden, the relationship between costs and disease severity, and possible changes in the costs during the last decade. Subjects with COPD derived from the general population in Northern Sweden were interviewed by telephone regarding their resource utilisation and productivity losses four times quarterly during 2009-10. Mean annual costs were estimated for each severity stage of COPD. A strong relationship was found between disease severity and costs. Estimated mean annual costs per subject of mild, moderate, severe and very severe COPD amounted to 596 (SEK 5686), 3245 (SEK 30,957), 5686 (SEK 54,242), and 17,355 euros (SEK 165,569), respectively. The main cost drivers for direct costs were hospitalisations (for very severe COPD) and drugs (all other severity stages). The main cost driver for indirect costs was productivity loss due to sick-leave (for mild COPD) and early retirement (all other severity stages). Costs appeared to be lower in 2010 than in 1999 for subjects with severe and very severe COPD, but higher for those with mild and moderate COPD. Our results show that costs of COPD are strongly related to disease severity, and scaling the data to the whole Swedish population indicates that the total costs in Sweden amounted to 1.5 billion euros (SEK 13.9 bn) in 2010. In addition, costs have decreased since 1999 for subjects with severe and very severe COPD, but increased for those with mild and moderate COPD.Respiratory medicine 08/2013; · 2.33 Impact Factor