Study Finds 3-Fold Higher Care Costs for Patients With COPD Than Healthy Patients

Total annual health care costs, including direct and indirect costs, were 3 times higher for patients with chronic obstructive pulmonary disease (COPD) than patients without COPD, said investigators of a recent study published in the International Journal of Chronic Obstructive Pulmonary Disease.

“Prevention of severe comorbidities and managing them more effectively would not only be of benefit for the patients but could potentially also relieve much of the financial burden of disease,” noted the investigators.

The nationwide study from Denmark is among the few studies to evaluate the longitudinal economic impact of COPD care, assess the influence of indirect costs, and use population-based matched controls. Furthermore, the study is the first to look at the link between dyspnea symptoms and costs, the authors said.

In the European Union, direct costs of respiratory diseases are estimated to make up 6% of total health expenses, with COPD accounting for 56% and equaling €38.6 (US $45.4) billion. In the United States, direct costs associated with COPD amount to $32 billion and indirect costs are $20.4 billion.

The direct costs associated with COPD treatment and care are primarily composed of exacerbation-related costs, hospitalizations, outpatient follow-up care, general practitioner visits, medications, laboratory tests, and rehabilitation programs. Indirect costs refer to costs associated with loss of productivity, such as disability benefits, unemployment benefits, and social transfer payments. Information on indirect costs is generally not available.

Denmark has a high COPD prevalence, with 270,000 Danish residents having moderate-to-severe COPD, based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity classification scale.

The investigators enrolled 49,826 patients with COPD aged 40 or older, who received a diagnosis between 2008 and 2016, and were entered into the nationwide Danish COPD Registry. The mean age of the COPD group was 69.2 years and 52% of the cohort were women.

The costs were calculated during a 12-month post-index follow-up period. The mean costs associated with moderate and severe exacerbations were calculated based on health care resource utilization over the first 28 days after the start of an exacerbation event.

The patients were matched 4:1 to a population-based non-COPD reference population consisting of 196,623 individuals and were classified into 1 of 4 GOLD criteria groups, ranging alphabetically from Group A, least severe, to Group D, most severe.

The total costs, including direct costs for elderly care and retirement home costs, were €28,969 (US$34,096) for patients with COPD and €10,693 (US $12,585) for the reference population. A similar gap was seen across all GOLD groups and their individually matched comparisons. Indirect costs for the total COPD population were €6773 (US $7971.75).

Group A exhibited the lowest amount of direct cost and Group D had the highest. Groups B and C were fairly equal and were in between the costs associated with Groups A and D.

When including antibiotics into total direct costs, they amounted to €8324 (US $9797.26) for Group A, €12,295 (US $14,471.09) for Group B, €10,702 ($12,596) for Group C, and €16,930 (US $19,926.44) for Group D.

Direct costs were largely influenced by costs related to hospitalizations, outpatient visits, and prescription drugs. Another major driver of direct costs was severe exacerbations. The mean costs were €888 (US $1045.17) per moderate exacerbation and €7091 (US $8346.04) per severe exacerbation. The costs of exacerbations were not significantly different between GOLD groups.

The amount of yearly exacerbation doubled for GOLD groups A and B during the follow-up year, driven by an increase in severe exacerbations. The rates of moderate and severe exacerbations were lower among patients in GOLD groups C and D during the same period.

“The increase in severe exacerbations in GOLD groups A and B during follow-up points towards the importance of earlier diagnosis and management of COPD, as this would not only benefit patients, but hopefully also reduce the economic burden of disease by interrupting the progression of mild and moderate patients with COPD to more severe stages of disease,” wrote the investigators.

A study strength noted by the investigators was the large sample size. However, they said that because the sample was identified in a hospital setting, the cohort may potentially reflect a more severe COPD population than in the real world and result in higher cost estimates.

Reference

Løkke A, Lange P, Lykkegaard J, et al. Economic burden of COPD by disease severity—A nationwide cohort study in Denmark. Int J Chron Obstruct Pulmon Dis. Published online March 10, 2021. doi:10.2147/COPD.S295388