Economic Burden of COPD by Disease Severity – A Nationwide Cohort Study in Denmark

Abstract

Anders Løkke,1,2 Peter Lange,3,4 Jesper Lykkegaard,5 Rikke Ibsen,6 Maria Andersson,7 Sofie de Fine Licht,8 Ole Hilberg1,2 1Department of Medicine, Little Belt Hospital, Vejle, Denmark; 2Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 3Medical Department, Copenhagen University Hospital-Herlev, Herlev, Denmark; 4Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark; 5Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark; 6i2Minds, Aarhus, Denmark; 7AstraZeneca Nordic, IVS & Health Economics, Södertälje, Sweden; 8AstraZeneca Nordic,Medical & Regulatory, Södertälje, SwedenCorrespondence: Anders LøkkeUniversity of Southern Denmark, Odense, DenmarkEmail [email protected]: Chronic Obstructive Pulmonary Disease (COPD) carries a considerable economic burden, both for individuals and societies. This study aimed to assess direct and indirect costs associated with COPD, and how costs vary across disease severity.Methods: This was a nationwide, population-based cohort study utilizing Danish health registries. Patients; ≥ 40 years of age, with an in- and/or outpatient diagnosis of COPD (ICD-10 J44) in 2008– 2016, were identified in the nationwide Danish COPD Registry. Included patients were matched 1:4 to a population-based non-COPD reference population of 196,623 individuals by sex, year of birth, co-habitation status, and municipality. Patients were grouped by disease severity according to different characteristics including GOLD groups A-D, based on moderate (short-term oral corticosteroid use), presence of severe exacerbations (emergency visit or hospitalization) and symptom score. Index was the date of the first outpatient visit with a symptom score registration. The costs were calculated during a 12 months post-index follow-up.Results: In all, 49,826 patients with COPD (mean age 69.2 years, 52% females) were included. Total annual costs, including direct costs, costs for elderly care, and costs for retirement home, were higher for patients with COPD (€ 28,969) compared with the reference population (€ 10,6913). In GOLD groups A-D, the total direct costs were A: € 8,766, B: € 13,060, C: € 11,113, and D: € 17,749, respectively. A major driver of direct costs was severe exacerbations. The mean costs per moderate and severe exacerbation were € 888 and € 7,091, respectively, during 28 days of follow-up. The costs for non-COPD-related Health Care Resource Utilization were higher than the COPD-related costs in GOLD groups A-C, but not in GOLD group D.Conclusion: In this nationwide real-world study, total direct costs were three-fold higher among patients with COPD compared with the reference population. Severe exacerbations were a major driver of the direct costs. The costs increased with increasing disease severity.Keywords: COPD, exacerbations, symptoms, cost, GOLD

Keywords

• copd
• exacerbations
• symptoms
• cost
• gold