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Pham HQ, Pham KHT, Ha GH, Pham TT, Nguyen HT, Nguyen THT, Oh JK. Economic Burden of Chronic Obstructive Pulmonary Disease: A Systematic Review. Tuberc Respir Dis (Seoul) 2024; 87:234-251. [PMID: 38361331 PMCID: PMC11222094 DOI: 10.4046/trd.2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/30/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
Globally, providing evidence on the economic burden of chronic obstructive pulmonary disease (COPD) is becoming essential as it assists the health authorities to efficiently allocate resources. This study aimed to summarize the literature on economic burden evidence for COPD from 1990 to 2019. This study examined the economic burden of COPD through a systematic review of studies from 1990 to 2019. A search was done in online databases, including Web of Science, PubMed/Medline, Scopus, and the Cochrane Library. After screening 12,734 studies, 43 articles that met the inclusion criteria were identified. General study information and data on direct, indirect, and intangible costs were extracted and converted to 2018 international dollars (Int$). Findings revealed that the total direct costs ranged from Int$ 52.08 (India) to Int$ 13,776.33 (Canada) across 16 studies, with drug costs rannging from Int$ 70.07 (Vietnam) to Int$ 8,706.9 (China) in 11 studies. Eight studies explored indirect costs, while one highlighted caregivers' direct costs at approximately Int$ 1,207.8 (Greece). This study underscores the limited research on COPD caregivers' economic burdens, particularly in developing countries, emphasizing the importance of increased research support, particularly in high-resource settings. This study provides information about the demographics and economic burden of COPD from 1990 to 2019. More strategies to reduce the frequency of hospital admissions and acute care services should be implemented to improve the quality of COPD patients' lives and reduce the disease's rising economic burden.
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Affiliation(s)
- Hai Quang Pham
- Department of Health Economics, School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Kiet Huy Tuan Pham
- Department of Health Economics, School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Giang Hai Ha
- Institute of Theoretical and Applied Research, Duy Tan University, Danang, Vietnam
- School of Business and Economics, Duy Tan University, Danang, Vietnam
| | - Tin Trung Pham
- Can Tho University of Medicine and Pharmacy, Faculty of Public Health, Can Tho, Vietnam
| | - Hien Thi Nguyen
- Can Tho University of Medicine and Pharmacy, Faculty of Public Health, Can Tho, Vietnam
| | - Trang Huyen Thi Nguyen
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jin-Kyoung Oh
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
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2
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Mountain R, Kim D, Johnson KM. Budget impact analysis of adopting primary care-based case detection of chronic obstructive pulmonary disease in the Canadian general population. CMAJ Open 2023; 11:E1048-E1058. [PMID: 37935489 PMCID: PMC10635706 DOI: 10.9778/cmajo.20230023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND An estimated 70% of Canadians with chronic obstructive pulmonary disease (COPD) have not received a diagnosis, creating a barrier to early intervention, and there is growing interest in the value of primary care-based opportunistic case detection for COPD. We sought to build on a previous cost-effectiveness analysis by evaluating the budget impact of adopting COPD case detection in the Canadian general population. METHODS We used a validated discrete-event microsimulation model of COPD in the Canadian general population aged 40 years and older to assess the costs of implementing 8 primary care-based case detection strategies over 5 years (2022-2026) from the health care payer perspective. Strategies varied in eligibility criteria (based on age, symptoms or smoking history) and testing technology (COPD Diagnostic Questionnaire [CDQ] or screening spirometry). Costs were determined from Canadian studies and converted to 2021 Canadian dollars. Key parameters were varied in one-way sensitivity analysis. RESULTS All strategies resulted in higher total costs compared with routine diagnosis. The most cost-effective scenario (the CDQ for all patients) had an associated total budget expansion of $423 million, with administering case detection and subsequent diagnostic spirometry accounting for 86% of costs. This strategy increased the proportion of individuals diagnosed with COPD from 30.4% to 37.8%, and resulted in 4.6 million referrals to diagnostic spirometry. Results were most sensitive to uptake in primary care. INTERPRETATION Adopting a national COPD case detection program would be an effective method for increasing diagnosis of COPD, dependent on successful uptake. However, it will require prioritisation by budget holders and substantial additional investment to improve access to diagnostic spirometry.
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Affiliation(s)
- Rachael Mountain
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences (Mountain, Johnson), University of British Columbia, Vancouver, BC; Centre for Health Informatics, Computing, and Statistics (Mountain), Lancaster Medical School, Lancaster University, Lancaster, UK; Faculty of Medicine (Kim) and Division of Respiratory Medicine, Department of Medicine (Johnson), University of British Columbia, Vancouver, BC
| | - Dexter Kim
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences (Mountain, Johnson), University of British Columbia, Vancouver, BC; Centre for Health Informatics, Computing, and Statistics (Mountain), Lancaster Medical School, Lancaster University, Lancaster, UK; Faculty of Medicine (Kim) and Division of Respiratory Medicine, Department of Medicine (Johnson), University of British Columbia, Vancouver, BC
| | - Kate M Johnson
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences (Mountain, Johnson), University of British Columbia, Vancouver, BC; Centre for Health Informatics, Computing, and Statistics (Mountain), Lancaster Medical School, Lancaster University, Lancaster, UK; Faculty of Medicine (Kim) and Division of Respiratory Medicine, Department of Medicine (Johnson), University of British Columbia, Vancouver, BC
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3
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Greek Guidelines for the Management of COPD, a Proposal of a Holistic Approach Based on the needs of the Greek Community. J Pers Med 2022; 12:jpm12121997. [PMID: 36556218 PMCID: PMC9788491 DOI: 10.3390/jpm12121997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
Despite that COPD remains one of the most common respiratory diseases worldwide, it can be managed effectively with certain treatments and, more importantly, be prevented by the early implementation of various measures. The pathology and pathophysiology of this disease continue to be studied, with new pharmacological and invasive therapies emerging. In this consensus paper, the Working Group of the Hellenic Thoracic Society aimed to consolidate the up-to-date information and new advances in the treatment of COPD. Local and international data on its prevalence are presented, with revised strategies on the diagnostic approach and the evaluation of risk assessment and disease severity classification. Emphasis is placed on the management and therapy of patients with COPD, covering both common principles, specialized modalities, and algorithms to distinguish between home care and the need for hospitalization. Although pharmacological treatment is commonly recognized in COPD, an integrative approach of pulmonary rehabilitation, physical activity, patient education, and self-assessment should be encountered for a comprehensive treatment, prevention of exacerbations, and increased quality of life in patients.
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The Association between Medical Utilization and Chronic Obstructive Pulmonary Disease Severity: A Comparison of the 2007 and 2011 Guideline Staging Systems. Healthcare (Basel) 2022; 10:healthcare10040721. [PMID: 35455899 PMCID: PMC9024555 DOI: 10.3390/healthcare10040721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: This study aimed to investigate the associations between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging systems, medical costs, and mortality among patients with chronic obstructive lung disease (COPD). Predictions of the effectiveness of the two versions of the staging systems were also compared. (2) Purpose: this study investigated the associations between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging systems, medical costs, and mortality among patients with COPD. Predicting effectiveness between the two versions of the staging systems was also compared. (3) Procedure: This study used a secondary clinical database of a medical center in central Taiwan to examine records between 2011 and 2017. A total of 613 patients with COPD were identified. The independent variables comprised the COPD GOLD Guideline staging of the 2007 and 2011 versions, demographic characteristics, health status, and physician seniority. The dependent variables included total medical cost, average length of hospital stay, and mortality. The statistical methods included binomial logistic regression and the general linear model (GLM). (4) Discussion: The total medical cost during the observation period for patients with COPD averaged TWD 292,455.6. The average length of hospital stay was 9.7 days. The mortality rate was 9.6%, compared with that of patients in Grade 1 of the 2007 version; patients in Grade 4 of the 2007 version had significantly higher odds of death (OR = 4.07, p = 0.02). The accuracy of mortality prediction for both the 2007 and 2011 versions of the staging was equal, at 90.4%. The adjusted GLM analysis revealed that patients in Group D of the 2011 version had a significantly longer length of hospital stay than those in Group A of the 2011 version (p = 0.04). No difference between the 2007 and 2011 versions was found regarding the total medical cost. Complications were significantly associated with the total medical cost and average length of hospital stay. (5) Conclusions: The COPD staging 2011 version was associated with an average length of hospital stay, whereas the COPD staging 2007 version was related to mortality risk. Therefore, the 2011 version can estimate the length of hospital stay. However, in predicting prognosis and mortality, the 2007 version is recommended.
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Gutiérrez Villegas C, Paz-Zulueta M, Herrero-Montes M, Parás-Bravo P, Madrazo Pérez M. Cost analysis of chronic obstructive pulmonary disease (COPD): a systematic review. HEALTH ECONOMICS REVIEW 2021; 11:31. [PMID: 34403023 PMCID: PMC8369716 DOI: 10.1186/s13561-021-00329-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a treatable disease with a high prevalence, and high morbidity associated with significant socioeconomic costs. OBJECTIVE To carry out a systematic review of the literature to analyze the main cost studies associated with COPD, in order to determine the main factors that influence the costs of the disease. METHODS Searches were conducted in PubMed, SCOPUS and Web of Science databases for cost studies on COPD published in English, between the years 2015 and 2020. The search terms were "COPD" OR "pulmonary disease, chronic obstructive", "cost*" OR "cost of illness", "economic impact" AND "burden of disease". The inclusion criteria included the identification of reported cost of the disease, economic burden, medical care expenses or use resources for COPD, the methodology used, data sources, and variables studied. RESULTS 18 publications were analyzed: 17 included direct health costs, 6 included direct non-medical costs, 12 analyzed indirect costs and two reported intangible costs. Most of the studies reported data for developed and European countries, with direct costs being the most studied. Trends were observed in multiple studies of direct and healthcare costs for European countries measured by patient and year, where the higher costs were associated with more severe COPD and a frequent history of exacerbations. The highest costs reported corresponded to hospitalizations and the associated pharmacological treatment. The importance of the loss of productivity and premature retirement within the profile of the COPD patient was also highlighted as the main generator of indirect costs of the disease. CONCLUSION COPD generates substantial costs for the health system, mainly related to moderate to severe stages and the exacerbations and complications entailed. It is important to strengthen health systems with monitoring, evaluation and health education models that allow these patients to remain stable to avoid decompensation and subsequent hospitalizations.
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Affiliation(s)
- Celia Gutiérrez Villegas
- IDIVAL, Research Institute Marqués de Valdecilla. C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - María Paz-Zulueta
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n. C.P, 39008 Santander, Cantabria Spain
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES. C/ Cardenal Herrera Oria s/n. C.P, 39011 Santander, Cantabria Spain
| | - Manuel Herrero-Montes
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n. C.P, 39008 Santander, Cantabria Spain
- IDIVAL, Grupo de Investigación en Enfermería. C/ Cardenal Herrera Oria s/n. C.P, 39011 Santander, Cantabria Spain
| | - Paula Parás-Bravo
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n. C.P, 39008 Santander, Cantabria Spain
- IDIVAL, Grupo de Investigación en Enfermería. C/ Cardenal Herrera Oria s/n. C.P, 39011 Santander, Cantabria Spain
| | - María Madrazo Pérez
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n. C.P, 39008 Santander, Cantabria Spain
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Kazibwe J, Tran PB, Annerstedt KS. The household financial burden of non-communicable diseases in low- and middle-income countries: a systematic review. Health Res Policy Syst 2021; 19:96. [PMID: 34154609 PMCID: PMC8215836 DOI: 10.1186/s12961-021-00732-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/30/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The chronic nature of noncommunicable diseases (NCD) and costs associated with long-term care can result in catastrophic health expenditure for the patient and their household pushing them deeper into poverty and entrenching inequality in society. As the full financial burden of NCDs is not known, the objective of this study was to explore existing evidence on the financial burden of NCDs in low- and middle-income countries (LMICs), specifically estimating the cost incurred by patients with NCDs and their households to inform the development of strategies to protect such households from catastrophic expenditure. METHODS This systematic review followed the PRISMA guidelines, PROSPERO: CRD42019141088. Eligible studies published between 1st January 2000 to 7th May 2020 were systematically searched for in three databases: Medline, Embase and Web of Science. A two-step process, comprising of qualitative synthesis proceeded by quantitative (cost) synthesis, was followed. The mean costs are presented in 2018 USD. FINDINGS 51 articles were included, out of which 41 were selected for the quantitative cost synthesis. Most of the studies were cross-sectional cost-of-illness studies, of which almost half focused on diabetes and/or conducted in South-East Asia. The average total costs per year to a patient/household in LMICs of COPD, CVD, cancers and diabetes were $7386.71, $6055.99, $3303.81, $1017.05, respectively. CONCLUSION This review highlighted major data and methodological gaps when collecting data on costs of NCDs to households along the cascade of care in LMICs. More empirical data on cost of specific NCDs are needed to identify the diseases and contexts where social protection interventions are needed most. More rigorous and standardised methods of data collection and costing for NCDs should be developed to enable comprehensive and comparable evidence of the economic and financial burden of NCDs to patients and households in LMICs. The available evidence on costs reveals a large financial burden imposed on patients and households in seeking and receiving NCD care and emphasizes the need for adequate and reliable social protection interventions to be implemented alongside Universal Health Coverage.
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Affiliation(s)
- Joseph Kazibwe
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Phuong Bich Tran
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden.
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Souliotis K, Silva Miguel L, Hillas G, Borges M, Papageorgiou G, Viana D, Malhadeiro J, Soulard S. The cost-saving switch from inhaled corticosteroid-containing treatments to dual bronchodilation: a two-country projection of epidemiological and economic burden in chronic obstructive pulmonary disease. Ther Adv Respir Dis 2021; 14:1753466620926802. [PMID: 32519591 PMCID: PMC7288795 DOI: 10.1177/1753466620926802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 recommendations support maintenance treatment with long-acting bronchodilators in most symptomatic patients with chronic obstructive pulmonary disease (COPD). While restricting the overuse of inhaled corticosteroids (ICS) may influence healthcare utilization required to treat inadvertent respiratory (exacerbations and pneumonia) and diabetes-related events, it may also change the total medication cost. This analysis was performed to estimate the 5-year budget impact of switching from ICS-containing treatment combinations to dual bronchodilation, in line with the recommendations. Methods: The model quantified the budget impact of treatment and healthcare resource utilization when COPD patients were anticipated to switch from ICS-containing treatments to dual bronchodilation. Three switch scenarios were calculated with increasing proportions of patients on dual long-acting bronchodilators, to the detriment of ICS-containing double and triple combinations. Clinical and cost input data were based on results from clinical trials and Greek and Portuguese healthcare cost databases. Results: Healthcare resource use to manage exacerbations, pneumonia and diabetes-related events were projected to increase between 2019 and 2023 in parallel with the growing COPD patient population and associated costs were estimated at 52–57% of the total disease cost in the Greek and Portuguese base case scenarios. Total cost savings between 21 and 112 million EUR were projected when the proportion of patients on double and triple ICS-containing treatments was gradually reduced to 50% in scenario A, 20% in scenario B and 7% in scenario C. Sensitivity analyses showed that none of the model assumptions had a major impact on the projected savings. Conclusion: The alignment of COPD treatment with current recommendations may bring clinical benefits to patients, without substantial cost increases and even cost savings for payers. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece.,Health Policy Institute, Athens, Greece
| | - Luís Silva Miguel
- The Centre for Evidence Based Medicine (CEMBE), Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Georgios Hillas
- 5th Pulmonary Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Margarida Borges
- The Centre for Evidence Based Medicine (CEMBE), Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | | | | | - Stéphane Soulard
- Boehringer Ingelheim, De Boelelaan 32, Amsterdam, 1083 HJ, The Netherlands
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Johnson KM, Sadatsafavi M, Adibi A, Lynd L, Harrison M, Tavakoli H, Sin DD, Bryan S. Cost Effectiveness of Case Detection Strategies for the Early Detection of COPD. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:203-215. [PMID: 33135094 DOI: 10.1007/s40258-020-00616-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The value of early detection and treatment of chronic obstructive pulmonary disease (COPD) is currently unknown. We assessed the cost effectiveness of primary care-based case detection strategies for COPD. METHODS A previously validated discrete event simulation model of the general population of COPD patients in Canada was used to assess the cost effectiveness of 16 case detection strategies. In these strategies, eligible patients (based on age, smoking history, or symptoms) received the COPD Diagnostic Questionnaire (CDQ) or screening spirometry, at 3- or 5-year intervals, during routine visits to a primary care physician. Newly diagnosed patients received treatment for smoking cessation and guideline-based inhaler pharmacotherapy. Analyses were conducted over a 20-year time horizon from the healthcare payer perspective. Costs are in 2019 Canadian dollars ($). Key treatment parameters were varied in one-way sensitivity analysis. RESULTS Compared to no case detection, all 16 case detection scenarios had an incremental cost-effectiveness ratio (ICER) below $50,000/QALY gained. In the most efficient scenario, all patients aged ≥ 40 years received the CDQ at 3-year intervals. This scenario was associated with an incremental cost of $287 and incremental effectiveness of 0.015 QALYs per eligible patient over the 20-year time horizon, resulting in an ICER of $19,632/QALY compared to no case detection. Results were most sensitive to the impact of treatment on the symptoms of newly diagnosed patients. CONCLUSIONS Primary care-based case detection programs for COPD are likely to be cost effective if there is adherence to best-practice recommendations for treatment, which can alleviate symptoms in newly diagnosed patients.
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Affiliation(s)
- Kate M Johnson
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, Canada
- Institute for Heart and Lung Health, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Amin Adibi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Larry Lynd
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Mark Harrison
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Hamid Tavakoli
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation (The James Hogg Research Centre), St. Paul's Hospital, Vancouver, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Liang L, Shang Y, Xie W, Shi J, Tong Z, Jalali MS. Trends in Hospitalization Expenditures for Acute Exacerbations of COPD in Beijing from 2009 to 2017. Int J Chron Obstruct Pulmon Dis 2020; 15:1165-1175. [PMID: 32547004 PMCID: PMC7247615 DOI: 10.2147/copd.s243595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the cause of substantial economic and social burden. We investigated trends in hospitalizations for acute exacerbation of COPD in Beijing, China, from 2009 to 2017. Patients and Methods Investigations were conducted using data from the discharge records of inpatients that were given a primary diagnosis of acute exacerbation of COPD. The dataset was a retrospective review of information collected from electronic medical records and included 315,116 admissions (159,368 patients). Descriptive analyses and multivariate regressions were used to investigate trends in per admission and per capita expenditures, as well as other potential contributing factors. Results The mean per admission expenditures increased from 19,760 CNY ($2893, based on USD/CNY=6.8310) in 2009 to 20,118 CNY ($2980) in 2017 (a growth rate of 0.11%). However, the per capita expenditures increased from 23,716 CNY ($3472) in 2009 to 31,000 CNY ($4538) in 2017 (a growth rate of 1.7%). In terms of per admission expenditures, drug costs accounted for 52.9% of the total expenditures in 2009 and dropped to 39.4% in 2017 (P trend < 0.001). The mean length of stay (LOS) decreased from 16.0 days to 13.5 days (P trend < 0·001). Age, gender, COPD type, LOS, and hospital level were all associated with per admission and per capita expenditures. Interpretation Relatively stable per admission expenditures along with the decline in drug costs and LOS reflect the effectiveness of cost containment on some indicators in China’s health care reform. However, the increase in hospitalization expenditures per capita calls for better policies for controlling hospitalizations, especially multiple admissions.
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Affiliation(s)
- Lirong Liang
- Department of Clinical Epidemiology & Tobacco Dependence Treatment Research, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yunxiao Shang
- School of Economics, Peking University, Beijing, People's Republic of China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, People's Republic of China
| | - Julie Shi
- School of Economics, Peking University, Beijing, People's Republic of China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
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10
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Rehman AU, Hassali MAA, Muhammad SA, Harun SN, Shah S, Abbas S. The economic burden of chronic obstructive pulmonary disease (COPD) in Europe: results from a systematic review of the literature. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:181-194. [PMID: 31564007 DOI: 10.1007/s10198-019-01119-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 09/13/2019] [Indexed: 05/20/2023]
Abstract
OBJECTIVES To find the economic burden of COPD and to identify the key cost drivers in the management of COPD patients across different European countries. BACKGROUND COPD is a major cause of mortality and morbidity and is associated with considerable economic burden on the individual and society. It limits the daily activities and working ability of the patients. METHODOLOGY We conducted a systematic search of PUBMED, SCIENCE DIRECT, Cochrane CENTRAL, SCOPUS, Google Scholar and SAGE Premier Databases to find scientific research articles evaluating the cost of COPD management from patient and societal perspective. RESULTS Estimated per patient per year direct cost in Norway, Denmark, Germany, Italy, Sweden, Greece, Belgium, and Serbia was €10,701, €9580, €7847, €7448, €7045, €2896, €1963, and €2047, respectively. Annual per patient cost of work productivity loss was highest in Germany as €5735 and lowest in Greece as €998. It was estimated as €4824, €2033 and €1298 in Bulgaria, Denmark and Sweden, respectively. Several factors found associated with increasing cost of COPD management that include but not limited to late diagnosis, severity of disease, frequency of exacerbation, hospital readmissions, non-adherence to the therapy and exposure to COPD risk factors. CONCLUSION Minimizing the COPD exacerbations and controlling the worsening of symptoms may potentially reduce the cost of COPD management at any stage.
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Affiliation(s)
- Anees Ur Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia.
- Faculty of Pharmacy, Bahauddin Zakariya University Multan, Multan, Pakistan.
| | - Mohamed Azmi Ahmad Hassali
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | | | - Sabariah Noor Harun
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Sameen Abbas
- Department of Pharmacy, Quaid e Azam University Islamabad, Islamabad, Pakistan
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11
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Anees Ur Rehman, Ahmad Hassali MA, Muhammad SA, Shah S, Abbas S, Hyder Ali IAB, Salman A. The economic burden of chronic obstructive pulmonary disease (COPD) in the USA, Europe, and Asia: results from a systematic review of the literature. Expert Rev Pharmacoecon Outcomes Res 2019; 20:661-672. [PMID: 31596632 DOI: 10.1080/14737167.2020.1678385] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Lack of information about economic burden of COPD is a major cause of lack of attention to this chronic condition from governments and policymakers. Objective: To find the economic burden of COPD in Asia, USA and Europe, and to identify the key cost driving factors in management of COPD patients. Methodology: Relevant studies assessing the cost of COPD from patient perspective or societal perspective were retrieved by thoroughly searching PUBMED, SCIENCE DIRECT, GOOGLE SCHOLAR, SCOPUS, and SAGE Premier Databases. Results: In the USA annual per patient direct medical cost and hospitalization cost were reported as $10,367 and $6852, respectively. In Asia annual per patient direct medical cost in Iran, Korea and Singapore was reported as $1544, $3077, and $2335, respectively. However, annual per patient hospitalization cost in Iran, Korea, Singapore, India, China, and Turkey was reported as $865, $1371, $1868, $296, $1477 and $1031, respectively. In Europe annual per patient direct medical cost was reported as $11,787, $10,552, $8644, $8203, $7760, $3190, $1889, $2162, and $2254 in Norway, Denmark, Germany, Italy, Sweden, Greece, Spain, Belgium, and Serbia, respectively. Conclusion: Limiting the disease to early stage and preventing exacerbations may reduce the cost of management of COPD.
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Affiliation(s)
- Anees Ur Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia , Penang, Malaysia.,Faculty of Pharmacy, Bahauddin Zakariya University Multan , Multan, Pakistan
| | - Mohamed Azmi Ahmad Hassali
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia , Penang, Malaysia
| | | | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University , Faisalabad, Pakistan
| | - Sameen Abbas
- Department of Pharmacy, Quaid e Azam University Islamabad , Islamabad, Pakistan
| | - Irfhan Ali Bin Hyder Ali
- Respiratory Department, Hospital Pulau Pinang, Penang, Ministry of Health Malaysia , Penang, Malaysia
| | - Ahmad Salman
- School of Management, COMSATS University Islamabad , Islamabad, Pakistan
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Zhang J, Yao W, You X, Liu T, Liu Y. Comparative analysis of medical expenditure with nebulized budesonide versus systemic corticosteroids in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease in China. Int J Chron Obstruct Pulmon Dis 2019; 14:1195-1207. [PMID: 31213797 PMCID: PMC6549719 DOI: 10.2147/copd.s182015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and is a leading cause of disability in China. Acute exacerbations of COPD (AECOPD) are a leading cause of hospitalizations, and account for a substantial proportion of medical expenditure. Corticosteroids are commonly used to manage AECOPD in hospitalized patients, so our objective was to analyze the total medical expenditure associated with nebulized budesonide (nBUD) vs. systemic corticosteroids (SCS) in this population. Patients and methods: A post-hoc analysis was carried out in 1,577 and 973 patients diagnosed with COPD who had received “any” nBUD or SCS regimen for AECOPD during hospitalization, respectively. Regimens included monotherapy, sequential therapy, and sequential-combination therapy. Comparative total medical expenditure was analyzed using a generalized linear model controlling for age, gender, comorbidities, smoking history, and respiratory failure or pneumonia on admission. Results: The total medical expenditure per capita with any nBUD or SCS regimen was CN¥11,814 (US$1,922) and CN¥12,153 (US$1,977), respectively. Any nBUD regimen was associated with a significant saving of 5.1% in expenditure compared with any SCS regimen (P=0.0341). Comorbidities, Type II respiratory failure, or pneumonia were patient factors associated with higher total medical expenditure (P<0.0001). In a subgroup analysis of the patients who received monotherapy, total medical expenditure was CN¥10,900 (US$1,773) for nBUD and CN¥11,581 (US$1,884) for SCS; nBUD was associated with a significant saving of 8.7% in expenditure compared with SCS (P=0.0013). Similarly, in patients with respiratory failure, treatment with any nBUD regimen was associated with a 10.6% saving in expenditure over any SCS regimen (P=0.0239); however, the same comparison was not significant in patients without respiratory failure (3.4%; P=0.2299). Conclusion: AECOPD is a leading cause of hospitalization in China, which places substantial burden on the healthcare system. This post-hoc analysis suggests that nBUD regimens are associated with lower medical expenditure than SCS regimens in hospitalized patients with AECOPD, and may reduce the financial burden of COPD. However, prospective studies evaluating the effectiveness of nBUD therapies are warranted.
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Affiliation(s)
- Jing Zhang
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wanzhen Yao
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xuedan You
- Medical Affairs, AstraZeneca, Beijing, People's Republic of China
| | - Tianyi Liu
- Medical Affairs, AstraZeneca, Beijing, People's Republic of China
| | - Yuantao Liu
- Medical Affairs, AstraZeneca, Shanghai, People's Republic of China
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Kourlaba G, Hillas G, Vassilakopoulos T, Maniadakis N. The Economic Burden of Chronic Obstructive Pulmonary Disease in Greece. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:111-121. [PMID: 30328016 DOI: 10.1007/s40258-018-0431-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death worldwide, imposing a substantial socioeconomic burden on societies and patients due to the long-term management required. OBJECTIVE To assess the economic burden of COPD in Greece and its potential determinants. METHODS A population-based, random-digit dialled, telephone nationwide survey was conducted to recruit patients with COPD in Greece (N = 351). A structured questionnaire was used to collect data. The total annual cost per patient from a societal perspective was calculated. RESULTS The mean (95% CI) annual total cost per patient for the management of COPD from a societal perspective was €2150 (€1879-€2443). The total annual cost was mainly driven by the medication cost (36.1%), followed by the cost of hospitalizations (26.7%) and long-term oxygen therapy (13.8%). Multiple generalized linear model revealed that age, COPD Assessment Test (CAT) score and exacerbations were independently associated with the total annual cost. CONCLUSION Investment in interventions aiming at delaying progression of disease, preventing acute exacerbations, and managing chronic symptoms are required to reduce the overall economic burden of COPD in Greece.
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Affiliation(s)
| | - Georgios Hillas
- Department of Critical Care of Evangelismos Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Critical Care of Evangelismos Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Maniadakis
- Department οf Health Services Organization and Management, National School οf Public Health, Athens, Greece
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