Chest
Volume 118, Issue 5, November 2000, Pages 1278-1285
Journal home page for Chest

Clinical Investigations
COPD
Pharmacoeconomic Evaluation of COPD

https://doi.org/10.1378/chest.118.5.1278Get rights and content

Study objectives

The clinical outcomes and health-carecosts of a cohort of 413 patients with COPD are reported.

Design

This study was a retrospective pharmacoeconomicanalysis.

Setting

University teaching hospital andaffiliated clinics.

Patients

COPD patients with anFEV1 < 65% of predicted and an FEV1/FVCratio < 70% were eligible to be included in this analysis.

Interventions

Health-care resource utilization and costswere identified through chart review and were stratified according tothe severity of COPD using the American Thoracic Society stages I, II,and III. The pharmacoeconomic analysis was a cost-of-illness evaluationthat included the acquisition costs of initially prescribed pulmonarydrugs, acquisition cost of pulmonary drugs added during the follow-upperiod, oxygen therapy, laboratory and diagnostic test costs, clinicvisit costs, and emergency department and hospital costs.

Results

Total treatment cost was highly correlated withdisease severity, with stage I COPD having the lowest cost ($1,681 perpatient per year), stage III COPD having the highest cost ($10,812 perpatient per year), and stage II COPD having a cost intermediate tostage I and stage III ($5,037 per patient per year). With the exceptionof add-on drug acquisition cost, all cost variables were the highest instage III COPD, the lowest in stage I COPD, and intermediate in stageII COPD. Hospitalization was the most important cost variable for allthree stages of COPD severity. When stratified by both disease severityand initial bronchodilator drug selection, ipratropium alone in stage ICOPD patients and the combination of ipratropium plus a β-agonist(with or without steroid therapy) in stage II and stage III COPDpatients had the lowest total costs. Reasons for the lower total costof the ipratropium and ipratropium plus β-agonist treatment groupsincluded lower add-on drug costs, fewer diagnostic and laboratorytests, and a lower utilization rate for clinic visits, emergencydepartment visits, and hospitalizations.

Conclusions

Our study demonstrates a strong correlation between disease severityand total treatment cost in COPD. In addition, the type ofbronchodilator therapy impacts total cost in COPD. In stage I COPD,ipratropium alone had the lowest total cost, while in stage II andstage III COPD, a combination of ipratropium plus a β-agonist had thelowest total cost. These data support the concept that adherence topublished treatment guidelines will result in lower health-care costsdue to COPD.

Section snippets

Patients

This study was a retrospective evaluation of patients with adiagnosis of COPD identified between January 1993 and December 1994.Patients aged 35 to 80 years without restriction to gender or race wereincluded. Patients with a diagnosis of COPD, emphysema, and/or chronicbronchitis as defined by the ATS were eligible to beincluded.7 Patients were included irrespective of whetherCOPD was the primary, secondary, most responsible, or a complicatingdiagnosis. Eligible patients had a maximum ratio ofFEV

Results

A total of 413 patients were initially identified and included inthe analysis. Patients were stratified by the severity of COPD based onFEV1% of predicted criteria. There were 209patients with stage I COPD, 114 patients with stage II COPD, and 90patients with stage III COPD. Demographic and clinical characteristicsof the study patients at the time of identification in 1993 or 1994 aresummarized in Table 2. Significantly fewer stage III patients were current smokers, comparedto stage I or stage

Discussion

To our knowledge, the results of our study represent the firstcomprehensive cost analysis of patients with COPD. The overall directmedical costs of treating COPD in the United States are substantial andhave been estimated to be just > $15 billionannually.3456 In our study, the severity of COPD and thetype of drugs used in the management of COPD influenced the subsequentcost of treatment. It is not surprising that patients with more severedisease had higher costs. Patients with stage II and

References (16)

There are more references available in the full text version of this article.

Cited by (236)

  • Qualitative emphysema and risk of COPD hospitalization in a multicenter CT lung cancer screening cohort study

    2021, Respiratory Medicine
    Citation Excerpt :

    Projections estimate that $49 billion will be spent in the United States on medical treatment for COPD in 2020 [5]. The average hospitalization cost for a single episode of COPD exacerbation is approximately $7,100, and the aggregate of hospitalization costs accounts for 45–50% of COPD-related health care expenditures [6–10]. Smoking cessation programs, vaccination against pneumococcal pneumonia, and referral to a pulmonary specialist have all been shown to reduce hospitalizations and improve outcomes in patients with COPD [11–17].

View all citing articles on Scopus

Funded by grants from the Health Futures Foundation, Omaha, NE, andBoehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT. Dr.Hilleman has received honoraria for lectures from Boehringer Ingelheim, Wyeth-Ayerst, Roche Pharmaceuticals,Pfizer, and Merck, Inc. Dr. Friedman holds grants from BoehringerIngelheim, Glaxo Wellcome, Inc., Merck, Inc., Schering Plough, andSmithKline Beecham.

View full text