Economic Overview of the Health Care of Patients with Chronic Obstructive Pulmonary Disease
Keywords:
chronic obstructive pulmonary disease, direct costs, indirect costs, economic evaluation, health care.Abstract
Introduction: Chronic obstructive pulmonary disease has a prevalence of 10.2 % in the world population aged 40 to 80 years, but some reports indicate prevalences of 15.0 % and 20.6 % for this same population. This disease generates important costs for the health system, mainly in the moderate and severe stages, exacerbations and complications.
Objective: To describe the economic landscape of health care for patients with chronic obstructive pulmonary disease in different countries of the world.
Procedures used for the collection of information: A narrative review was carried out by searching information in the databases Biomed Central, Wiley Online Library, Scielo Regional, SciELO Cuba and Elsevier. Articles in English and Spanish were analyzed and 75 of them were consulted, of which 41 were included, published between 2005 and 2023. The inclusion criteria were the presence of epidemiological information, diagnosis, treatment and direct and indirect costs. Thirty-four articles with other types of economic evaluation were excluded. Of the included articles, more than 50% corresponded to a period of less than 5 years.
Results: Regardless of the region, the care of patients with chronic obstructive pulmonary disease had an approximate cost per patient of US$ 6000 per year. The largest proportion corresponded to direct costs derived from exacerbations ranging from 70 to 90 % of the total cost.
Conclusions: Chronic obstructive pulmonary disease generated very high costs. Minimizing disease exacerbations, controlling worsening, smoking prevention, and controlling other environmental factors could potentially reduce the cost of treatment.Downloads
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References
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15. Chen X, Sun W, Li S, Wang X, Huang M and Ningfei J. Current status of prevention and treatment of respiratory diseases in primary care in China: a cross-sectional study. BMC Pulm Med. 2022;22:156. DOI: 10.1186/s12890-022-01956-6
16. Boland MR, Tsiachristas A, Kruis AL, Chayannes NH, Maureen PMH, Rutten van M. The health economic impact of disease management programs for COPD: a systematic literature review and meta-analysis. BMC Pulm Med. 2013;13:40. DOI: 10.1186/1471-2466-13-40
17. Punekar YS, Landis SH, Wurst K, Le H. Characteristics, disease burden and costs of COPD patients in the two years following initiation of long-acting bronchodilators in UK primary care. Respir Res. 2015;16:141. DOI: 10.1186/s12931-015-0295-2
18. Boggon R, Hubbard R, Smeeth L, Gulliford M, Cassell J, Eaton S, Pirmohamed M, Van Staa TP. Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study. BMC Pulm Med. 2013;13:32. DOI: 10.1186/1471-2466-13-32
19. Nielsen H, Gudik Sorensen ML, Sogaard KE, Dyrholm V. The use of antibiotics in treatment of acute COPD exacerbations does not adhere to national guidelines. Scand J Trauma Resusc Emerg Med. 2010;18(1):O3. DOI: 10.1186/1757-7241-18-S1-O3
20. Hopkinson NS, Molyneux A, Pink J, Harrisingh MC. Enfermedad pulmonar obstructiva crónica: diagnóstico y manejo: resumen de la guía NICE actualizada. BMJ. 2019;366. DOI: 10.1136/bmj.l4486
21. Hoult G, Gillespie D, Wilkinson TMA. Biomarkers to guide antibiotic use for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis. BMC Pulm Med. 2022;22:194 (2022). DOI: 10.1186/s12890-022-01958-4
22. Bakerly ND, Browning D, Boucot I, Crawford J, McCorkindale S, Stein N, et al. The impact of fluticasone furoate/vilanterol on healthcare resource utilisation in the Salford Lung Study in chronic obstructive pulmonary disease. Ther Adv Respir Dis. 2021;15:17534666211001013. DOI: 10.1177/17534666211001013
23. Kirsch F, Schramm A, Schwarzkopf L, Lutter JI, Szentes B, Huber M, et al. Direct and indirect costs of COPD progression and its comorbidities in a structured disease management program: results from the LQ-DMP study. Respir Res. 2019;20(1):215. DOI: 10.1186/s12931-019-1179-7
24. Larsson K, Janson C, Ställberg B, Lisspers K, Olsson P, Kostikas K, et al. Impact of COPD diagnosis timing on clinical and economic outcomes: the ARCTIC observational cohort study. Int J Chron Obstruct Pulmon Dis. 2019;14:995-1008. DOI: 10.2147/COPD.S195382
25. Patel JG, Coutinho AD, Lunacsek OE, Dalal AA. COPD affects worker productivity and health care costs. Int J Chron Obstruct Pulmon Dis. 2018;13:2301-11. DOI: 10.2147/COPD.S163795
26. Stafyla E, Geitona M, Kerenidi T, Economou A, Daniil Z, Gourgoulianis KI. The annual direct costs of stable COPD in Greece. Int J Chron Obstruct Pulmon Dis. 2018;13:309-15. DOI: 10.2147/COPD.S148051
27. Rehman AU, Ahmad Hassali MAA, Ayaz Muhammad SA, Harún SN, Shh S, Abbas S. The economic burden of chronic obstructive pulmonary disease (COPD) in Europe: results from a systematic review of the literature. Eur J Health Econ. 2020;21(2):181-94. DOI: 10.1007/s10198-019-01119-1
28. Byng D, Lutter JI, Wacker ME, Jörres RA, Liu X, Karrasch S, et al. Determinants of healthcare utilization and costs in COPD patients: first longitudinal results from the German COPD cohort COSYCONET. Int J Chron Obstruct Pulmon Dis. 2019;14:1423-39. DOI: 10.2147/COPD.S201899
29. Zhu B, Wang Y, Ming J, Chen W, Zhang L. Disease burden of COPD in China: a systematic review. Int J Chron Obstruct Pulmon Dis. 2018;13:1353-64. DOI: 10.2147/COPD.S161555
30. Woo L, Smith HE, Sullivan SD. The economic burden of chronic obstructive pulmonary disease in the Asia-Pacific Region: A systematic review. Value Health Reg Issues. 2019;18:121-31. DOI: 10.1016/j.vhri.2019.02.002
31. Ur Rehman A, Hassali MAA, Muhammad SA, Shakeel S, Chin OS, Ali IABH, et al. Economic Burden of Chronic Obstructive Pulmonary Disease Patients in Malaysia: A Longitudinal Study. Pharmacoecon Open. 2021;5(1):35-44. DOI: 10.1007/s41669-020-00214-x
32. Blanchette CM, Gross NJ, Altman P. Rising Costs of COPD and the Potential for Maintenance Therapy to Slow the Trend. Am Health Drug Benefits. 2014 [acceso 10/09/2022];7(2):98-106. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24991394/
33. Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli GJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J. 2019 [acceso 16/08/2022];53(5):1900164. Disponible en: https://erj.ersjournals.com/content/53/5/1900164
34. Martínez Luna M, Rojas Granados A, Lázaro Pacheco RI, Meza Alvarado JE, Ubaldo Reyes L, Ángeles Castellanos M. Enfermedad pulmonar obstructiva crónica (EPOC): Bases para el médico general. Rev Fac Med. (UNAM). 2020 [acceso 16/08/2022];63(3):28-35. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0026-17422020000300028
35. Guerrero López CM, Reynales Shigematsu LM, JiménezRuiz JA, Karam Araujo R, Maldonado Cruz CA, Camacho Solís R. Costos por ausentismo laboral atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social y en México, 2006-2009. Salud Pública de México. 2012 [acceso 12/08/2022];54(3):233-41. Disponible en: https://www.scielosp.org/pdf/spm/2012.v54n3/233-241
36. Reynales Shigematsu LM, Juárez Márquez SA, Valdés Salgado R. Costos de atención médica atribuibles al tabaquismo en el IMSS, Morelos. Salud Pública de México. 2005 [acceso 10/09/2022];47(6):451-7. Disponible en: https://www.scielo.org.mx/pdf/spm/v47n6/a10v47n6.pdf
37. Darnell K, Dwivedi AK, Weng Z, Panos R. Disproportionate utilization of healthcare resources among veterans with COPD: a retrospective analysis of factors associated with COPD healthcare cost. Cost Eff Resour Alloc. 2013;11:13. DOI: 10.1186/1478-7547-11-13
38. Iheanacho I, Zhang S, King D, Rizzo M, Ismaila AS. Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review. Int J Chron Obstruct Pulmon Dis. 2020;15:439-60. DOI: 10.2147/COPD.S234942
39. Lee CH, Kim MS, Yeo SH, Rhee CK, Heune Woo P, Yang BR, et al. Treatment patterns and cost of exacerbations in patients with chronic obstructive pulmonary disease using multiple inhaler triple therapy in South Korea. Respir Res. 2022;23:231. DOI: 10.1186/s12931-022-02136-0
40. Reyes GC, Silva OR, Saldias PF. Costo-efectividad de la rehabilitación respiratoria en pacientes con enfermedad pulmonar obstructiva crónica. Rev. Chil. Enferm. Respir. 2011 [acceso 10/09/2022];27(2):153-8. Disponible en: https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-73482011000200012&lng=en&nrm=iso&tlng=en
41. Kozma CM, Paris AL, Plauschinat CA. Comparison of resource use by COPD patients on inhaled therapies with long-acting bronchodilators: a database study. BMC Pulm Med. 2011;11: 61. DOI 10.1186/1471-2466-11-61
2. GOLD. Global Strategy for diagnosis, management and prevention of chronic obstructive pulmonary disease (2022 Report). EE.UU.: Global Initiative for COPD; 2022. Disponible en: https://goldcopd.org/wp-content/uploads/2021/12/GOLD-2022-ver-1.1-22Nov2021_WMV.pdf
3. Villarreal Ríos E, Julián Hernández YJ, Vargas Daza ER, Tapia Mendoza F, Galicia Rodríguez L, Martínez González L. Costo de la atención médica en pacientes con enfermedad pulmonar obstructiva crónica. Rev Med Inst Mex Seguro Soc. 2018 [acceso 10/09/2022];56(4):371-8. Disponible en: https://www.medigraphic.com/pdfs/imss/im-2018/im184j.pdf
4. De Betolaza S, Spiess C, Amaro M, Revello A, Rodríguez P, Sierra Gl. Impacto socioeconómico de pacientes asistidos en la policlínica de EPOC del Hospital Pasteur en 2018. Rev. Urug. Med. Int. 2022;7(1):4-16. DOI: 10.26445/07.01.1
5. Menezes AM, Perez Padilla R, Jardim JR, Muiño A, Lopez MV, Valdivia G, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. 2005; 366(9500):1875-81. DOI: 10.1016/S0140-6736(05)67632-5
6. Betancourt Peña J, Peñaranda Ospina E, Carvajal Riascos A, Ävila Valencia J, Benavides Córdova V. Condición clínica, capacidad funcional, ansiedad-depresión y calidad de vida en pacientes con EPOC con diferentes rangos de edad. Revista Cubana de Medicina General Integral. 2022 [acceso 10/08/2022];38(1). Disponible en: https://www.revmgi.sld.cu/index.php/mgi/article/view/1725
7. Varona Pérez P, Valdés Díaz S, Terry Valle O, Valdés Armenteros O, Gallego Ariosa G, Venero Fernández S, et al. Prevalencia y características de la enfermedad pulmonar obstructiva crónica en La Habana (2017-2018). Revista Cubana de Higiene y Epidemiología. 2022 [acceso 10/08/2022];59. Disponible en: https://www.revepidemiologia.sld.cu/index.php/hie/article/view/1177
8. Global Initiative for chronic obstructive lung disease. Global Strategy for Diagnosis, Management and Prevention or Chronic Obstructive pulmonary disease 2018 Report. Estados Unidos de América: GOLD; 2018 [acceso 22/03/2020]. Disponible en: https://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf
9. Global Initiative for chronic obstructive lung disease. Guía de bolsillo para el diagnóstico, manejo y prevención de la EPOC. Estados Unidos: GOLD; 2021 [acceso 25/03/2021]. Disponible en: https://goldcopd.org/wp-content/uploads/2022/01/GuiasGOLD2022_XXXXXv2_ES-Pocket.pdf
10. 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 Econ Rev. 2021;11(1):31. DOI: 10.1186/s13561-021-00329-9
11. Burgel PR, Laurendeau C, Raherison C, Fuhrman C, Roche N. An attempt at modeling COPD epidemiological trends in France. Respir Res.
2018,19(130). DOI: 10.1186/s12931-018-0827-7
12. Toquica Scott N, Sarduy Paneque M, Oramas Delgado M, Hechavarría Pouymiró S. Frecuencia de hipertensión pulmonar en pacientes con enfermedad pulmonar obstructiva crónica. Revista Cubana de Medicina. 2022 [acceso 31/08/2022];61(1) Disponible en: https://www.revmedicina.sld.cu/index.php/med/article/view/2546
13. Partridge MR. Enhancing the diagnosis and management of COPD in Primary care. Multidiscip Respir Med. 2014;9:62. DOI: 10.1186/2049-6958-9-62
14. Sanguinetti CM, De Benedetto F, Donner CF, Nardini https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-9-35 - auth-Stefano-Nardini-Aff4S, Visconti A. Pneumocafé project: an inquiry on current COPD diagnosis and management among General Practitioners in Italy through a novel tool for professional education Multidiscip Respir Med. 2014;9:35. DOI: 10.1186/2049-6958-9-35
15. Chen X, Sun W, Li S, Wang X, Huang M and Ningfei J. Current status of prevention and treatment of respiratory diseases in primary care in China: a cross-sectional study. BMC Pulm Med. 2022;22:156. DOI: 10.1186/s12890-022-01956-6
16. Boland MR, Tsiachristas A, Kruis AL, Chayannes NH, Maureen PMH, Rutten van M. The health economic impact of disease management programs for COPD: a systematic literature review and meta-analysis. BMC Pulm Med. 2013;13:40. DOI: 10.1186/1471-2466-13-40
17. Punekar YS, Landis SH, Wurst K, Le H. Characteristics, disease burden and costs of COPD patients in the two years following initiation of long-acting bronchodilators in UK primary care. Respir Res. 2015;16:141. DOI: 10.1186/s12931-015-0295-2
18. Boggon R, Hubbard R, Smeeth L, Gulliford M, Cassell J, Eaton S, Pirmohamed M, Van Staa TP. Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study. BMC Pulm Med. 2013;13:32. DOI: 10.1186/1471-2466-13-32
19. Nielsen H, Gudik Sorensen ML, Sogaard KE, Dyrholm V. The use of antibiotics in treatment of acute COPD exacerbations does not adhere to national guidelines. Scand J Trauma Resusc Emerg Med. 2010;18(1):O3. DOI: 10.1186/1757-7241-18-S1-O3
20. Hopkinson NS, Molyneux A, Pink J, Harrisingh MC. Enfermedad pulmonar obstructiva crónica: diagnóstico y manejo: resumen de la guía NICE actualizada. BMJ. 2019;366. DOI: 10.1136/bmj.l4486
21. Hoult G, Gillespie D, Wilkinson TMA. Biomarkers to guide antibiotic use for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis. BMC Pulm Med. 2022;22:194 (2022). DOI: 10.1186/s12890-022-01958-4
22. Bakerly ND, Browning D, Boucot I, Crawford J, McCorkindale S, Stein N, et al. The impact of fluticasone furoate/vilanterol on healthcare resource utilisation in the Salford Lung Study in chronic obstructive pulmonary disease. Ther Adv Respir Dis. 2021;15:17534666211001013. DOI: 10.1177/17534666211001013
23. Kirsch F, Schramm A, Schwarzkopf L, Lutter JI, Szentes B, Huber M, et al. Direct and indirect costs of COPD progression and its comorbidities in a structured disease management program: results from the LQ-DMP study. Respir Res. 2019;20(1):215. DOI: 10.1186/s12931-019-1179-7
24. Larsson K, Janson C, Ställberg B, Lisspers K, Olsson P, Kostikas K, et al. Impact of COPD diagnosis timing on clinical and economic outcomes: the ARCTIC observational cohort study. Int J Chron Obstruct Pulmon Dis. 2019;14:995-1008. DOI: 10.2147/COPD.S195382
25. Patel JG, Coutinho AD, Lunacsek OE, Dalal AA. COPD affects worker productivity and health care costs. Int J Chron Obstruct Pulmon Dis. 2018;13:2301-11. DOI: 10.2147/COPD.S163795
26. Stafyla E, Geitona M, Kerenidi T, Economou A, Daniil Z, Gourgoulianis KI. The annual direct costs of stable COPD in Greece. Int J Chron Obstruct Pulmon Dis. 2018;13:309-15. DOI: 10.2147/COPD.S148051
27. Rehman AU, Ahmad Hassali MAA, Ayaz Muhammad SA, Harún SN, Shh S, Abbas S. The economic burden of chronic obstructive pulmonary disease (COPD) in Europe: results from a systematic review of the literature. Eur J Health Econ. 2020;21(2):181-94. DOI: 10.1007/s10198-019-01119-1
28. Byng D, Lutter JI, Wacker ME, Jörres RA, Liu X, Karrasch S, et al. Determinants of healthcare utilization and costs in COPD patients: first longitudinal results from the German COPD cohort COSYCONET. Int J Chron Obstruct Pulmon Dis. 2019;14:1423-39. DOI: 10.2147/COPD.S201899
29. Zhu B, Wang Y, Ming J, Chen W, Zhang L. Disease burden of COPD in China: a systematic review. Int J Chron Obstruct Pulmon Dis. 2018;13:1353-64. DOI: 10.2147/COPD.S161555
30. Woo L, Smith HE, Sullivan SD. The economic burden of chronic obstructive pulmonary disease in the Asia-Pacific Region: A systematic review. Value Health Reg Issues. 2019;18:121-31. DOI: 10.1016/j.vhri.2019.02.002
31. Ur Rehman A, Hassali MAA, Muhammad SA, Shakeel S, Chin OS, Ali IABH, et al. Economic Burden of Chronic Obstructive Pulmonary Disease Patients in Malaysia: A Longitudinal Study. Pharmacoecon Open. 2021;5(1):35-44. DOI: 10.1007/s41669-020-00214-x
32. Blanchette CM, Gross NJ, Altman P. Rising Costs of COPD and the Potential for Maintenance Therapy to Slow the Trend. Am Health Drug Benefits. 2014 [acceso 10/09/2022];7(2):98-106. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24991394/
33. Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli GJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J. 2019 [acceso 16/08/2022];53(5):1900164. Disponible en: https://erj.ersjournals.com/content/53/5/1900164
34. Martínez Luna M, Rojas Granados A, Lázaro Pacheco RI, Meza Alvarado JE, Ubaldo Reyes L, Ángeles Castellanos M. Enfermedad pulmonar obstructiva crónica (EPOC): Bases para el médico general. Rev Fac Med. (UNAM). 2020 [acceso 16/08/2022];63(3):28-35. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0026-17422020000300028
35. Guerrero López CM, Reynales Shigematsu LM, JiménezRuiz JA, Karam Araujo R, Maldonado Cruz CA, Camacho Solís R. Costos por ausentismo laboral atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social y en México, 2006-2009. Salud Pública de México. 2012 [acceso 12/08/2022];54(3):233-41. Disponible en: https://www.scielosp.org/pdf/spm/2012.v54n3/233-241
36. Reynales Shigematsu LM, Juárez Márquez SA, Valdés Salgado R. Costos de atención médica atribuibles al tabaquismo en el IMSS, Morelos. Salud Pública de México. 2005 [acceso 10/09/2022];47(6):451-7. Disponible en: https://www.scielo.org.mx/pdf/spm/v47n6/a10v47n6.pdf
37. Darnell K, Dwivedi AK, Weng Z, Panos R. Disproportionate utilization of healthcare resources among veterans with COPD: a retrospective analysis of factors associated with COPD healthcare cost. Cost Eff Resour Alloc. 2013;11:13. DOI: 10.1186/1478-7547-11-13
38. Iheanacho I, Zhang S, King D, Rizzo M, Ismaila AS. Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review. Int J Chron Obstruct Pulmon Dis. 2020;15:439-60. DOI: 10.2147/COPD.S234942
39. Lee CH, Kim MS, Yeo SH, Rhee CK, Heune Woo P, Yang BR, et al. Treatment patterns and cost of exacerbations in patients with chronic obstructive pulmonary disease using multiple inhaler triple therapy in South Korea. Respir Res. 2022;23:231. DOI: 10.1186/s12931-022-02136-0
40. Reyes GC, Silva OR, Saldias PF. Costo-efectividad de la rehabilitación respiratoria en pacientes con enfermedad pulmonar obstructiva crónica. Rev. Chil. Enferm. Respir. 2011 [acceso 10/09/2022];27(2):153-8. Disponible en: https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-73482011000200012&lng=en&nrm=iso&tlng=en
41. Kozma CM, Paris AL, Plauschinat CA. Comparison of resource use by COPD patients on inhaled therapies with long-acting bronchodilators: a database study. BMC Pulm Med. 2011;11: 61. DOI 10.1186/1471-2466-11-61
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2023-05-15
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Sosa Lorenzo IA, Collazo Herrera M, Venero-Fernández S. Economic Overview of the Health Care of Patients with Chronic Obstructive Pulmonary Disease. INFODIR [Internet]. 2023 May 15 [cited 2026 Feb. 12];(41). Available from: https://revinfodir.sld.cu/index.php/infodir/article/view/1372
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b. The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (e.g., deposit it in an institutional telematic archive or publish it in a monographic volume) as long as the initial publication in this journal is indicated.
c. Authors are allowed and recommended to disseminate their work through the Internet (e.g.: in institutional telematic archives or in their web page) before and during the submission process, which may produce interesting exchanges and increase the number of citations of the published work. (See The effect of open access).
