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Background: Chronic obstructive pulmonary disease (COPD) is a devastating illness that affects 4.3% of the population of British Columbia over the age of 45 years. Asthma is known to coexist in 10-20% of individuals with obstructive lung disease, and adds to the substantial burden of illness posed by COPD alone. Inhaled corticosteroids (ICS) are currently recommended for the management of COPD among individuals with frequent exacerbations; however, the ability of inhaled corticosteroids to reduce death and hospitalizations among individuals with COPD is controversial. Less is known about the effectiveness of ICS among individuals who are afflicted with both COPD and asthma. Methods: We used a retrospective cohort study design and administrative data to estimate the relative effectiveness of ICS in reducing hospitalizations or death among individuals with concomitant asthma and COPD, compared with individuals with COPD alone. We used an extended Cox model to estimate this association, with a time-varying measure of exposure to ICS. Results: We did not find any association between ICS and hazard of death or hospitalization among individuals with COPD alone (HR = 0.99; 95% CI: 0.94-1.05), however the hazard was 18% lower (HR = 0.82; 95% CI: 0.69-0.99) among individuals with concomitant disease. Conclusions: Individuals with combined COPD and asthma show significant benefit from the use of ICS and are more responsive to the effects of ICS than individuals with COPD alone.

life years (QALYs) across the three approaches. Results: The estimates of the prior transition probabilities from the experts were feasible to obtain, and showed considerable consistency with the clinical trial data. As expected, the estimated health benefit of the treatments were different when only the clinical trial data were considered (QALY difference 0.0260) or its combination with the experts' beliefs were used in the economic model (QALY difference 0.0253), or when vague prior distributions were used (QALY difference 0.0243).Informative prior probability estimates were based on the opinion of only three experts. Conclusions: Imputing zeros to missing transition probabilities in Markov models might be untenable from the clinical perspective and may result in biased estimates. Bayesian statistics provides an appropriate framework for imputing missing values without making overly simplifying assumptions. Informative priors based on expert opinion might be more appropriate than vague priors.

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Objectives: COPD is a major public health problem in Turkey with high cost implications for the Social Security Institution (SSI). This study aimed at estimating the direct cost of COPD treatment based on Global Initiative for Lung Disease (GOLD) classifications of disease severity. MethOds: In the absence of a database, a panel approach was adopted to estimate direct costs from real world data. A survey was designed to obtain the type, amount and duration of resources used in the treatment of COPD according to each GOLD group. Five key opinion leaders with wide knowledge of clinical practice completed the survey. Diagnosis, treatment, monitoring, emergency and hospitalization costs were included. The costs of resources used in each GOLD group for diagnosis, treatment and monitoring were calculated by using the SSI's price tariff. Results: The annual weighted average cost per patient for GOLD A was 1,782.65 TL (776€ ). The costs were 2,952.79 TL (895€ ) for GOLD B, 4,079.14 TL (1,237€ ) for GOLD C and 5,098.98 TL (1,546€ ) for GOLD D. Overall cost to treat exacerbations was lowest in the GOLD A patients and highest in the GOLD D patients due to higher number of exacerbations in the latter group. cOnclusiOns: COPD is a major cause of mortality and morbidity especially in countries with high smoking rates. Cost of exacerbations comprise an important share of total costs, indicating a need for effective prevention strategies.