The annual cost of maintenance and exacerbation therapy for chronic obstructive pulmonary disease (COPD) exceeds $4000 per patient in Canada, reported M. Reza Maleki-Yazdi, MD, FRCPC, Division of Respi ratory Medicine, Women’s College Hospital, University of Toronto, Canada. The cost becomes higher as the number of exacerbations increases and as COPD severity increases.
“There are substantial cost, exacerbation frequency, and impairment in quality of life in all stages of COPD,” Dr Maleki-Yazdi said. “The results of this study highlight the importance of early detection of the subjects at risk of COPD exacerbations even in earlier stages of the disease.”
This 1-year study included 285 men (59.3%) and women, aged ≥50 years (mean age, 70.4), who had a diagnosis of COPD for at least 1 year. Mean pack-years of cigarettes smoked was 45.6; mean COPD duration, 8.2 years; and mean postbronchodilator into forced expiratory volume in 1 second (FEV1), 58% predicted.
The researchers reviewed patient charts and conducted patient surveys to gather information on healthcare resource utilization related to COPD maintenance and exacerbations. In addition, patients completed the EuroQol 5 Dimensions (EQ-5D) questionnaire on enrollment.
The average annual COPD-related cost per patient was $4147 (Table 1). The annual cost per patient increased with increasing COPD severity— measured by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging criteria—from $3525 per patient for those with GOLD stage I disease severity to $6141 per patient for those with GOLD stage IV severity.
The frequency of exacerbations by COPD severity is outlined in Table 2.
A total of 98 patients (34%) had 157 combined exacerbations. “Forty percent of annual COPD-related cost was due to exacerbations, and the percentage of the exacerbation cost contributing to the total cost of COPD increased with disease severity,” the researchers noted.
The mean cost per exacerbation was $3035, of which $2786 was direct costs and $249 was indirect costs (ie, the cost of patient’s and caregiver’s missed time from work). Treatments for exacerbations included medications and outpatient care, 19 visits to the emergency department, and 40 hospitalizations.
The mean scores for EQ-5D and the EQ visual analog scale (VAS) were 0.74 and 68.25, respectively. Although the EQ-5D and EQ VAS scores were as so ciated with COPD-related total costs and maintenance costs, the scores were not correlated with the FEV1 percent predicted or the exacerbation costs.