Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting

Abstract

Background: The aim of this study was to analyse the economic impact of nonadherence to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines in patients with chronic obstructive pulmonary disease (COPD). Methods: A retrospective analysis was carried out on a claim database. Patients aged at least 40 years with a diagnosis of COPD were eligible for this analysis. Demographics, medical data and use of resources were collected and direct and indirect costs were analysed (from January 2008 to June 2009). A probabilistic multivariate sensitivity analysis of avoided costs was carried out. All results are presented in annualized form and costs are expressed in Euros (2009). Results: A total of 1365 patients were included, 79.5% were men. The mean age (±standard deviation) was 71.4 (±10.3) years, the mean forced expiratory volume in 1 s (FEV 1) was 65.3% and they had a COPD history of 5.5 (±2.9) years. Patients were divided into an adherent group and a nonadherent group depending on whether therapeutic recommendations according to severity defined in the GOLD guidelines (2007) were followed. Patients in both groups were also classified as having stage II (FEV 1 < 80% and < 50%) or stage III disease (FEV 1 < 50% and ≥ 30%). The total annual drug cost per patient in the nonadherent group was €771.5 while it was only €426.4 for the adherent group. The average direct cost per patient per year in the nonadherent stage II group was €1465 (±971) and it rose to €2942 (±1918) for patients in the nonadherent group with stage III disease. The potential saving from the implementation of the GOLD guidelines in stage II COPD amounted to €758 per patient per year (68% saving on drug cost). In contrast, the cost for patients with stage III disease was higher in the adherent group versus the nonadherent group (€2468). Conclusions: The cost of COPD may vary according to compliance with the GOLD guidelines. The cost observed for patients with stage II disease is higher than expected in patients who adhere to treatment, but patients with stage III disease treated according to the GOLD guidelines had significantly higher treatment costs.

Brain health: time matters in multiple sclerosis

“…This annual cost per person is greater than that for other long-term conditions such as asthma (Braman, 2006), chronic obstructive pulmonary disease (a collection of chronic lung problems) (Chapman et al, 2006;Miravitlles et al, 2013) and diabetes (American Diabetes Association, 2013). It is also greater than the annual cost per person of most other brain disorders considered by the European Brain Council in a series of economic cost estimates (Olesen et al, 2012), apart from the neuromuscular condition Guillain-Barré syndrome (which costs approximately €54000 per person (Olesen et al, 2012), about 80% of whom do not have persistent neurological problems (Walling and Dickson, 2013)unlike in MS where accumulated disability is mostly irreversible) (Olesen et al, 2012).…”

Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)

“…[15] Notably, approximately 61% of the Spanish COPD patients are treated in primary care. [16] Factors that have been previously associated with ICS prescription include the performance of spirometry to confirm diagnosis, [17] severity of airflow obstruction, quality of life and emergency department visits in the last year; however, recent Spanish studies are limited. [13] The objective of this study was to assess the prescription rates of ICS and to identify sociodemographic and clinical factors associated with ICS prescription among patients with COPD, treated in Balearic primary healthcare.…”

Cost-effectiveness of indacaterol/glycopyrronium in comparison with salmeterol/fluticasone combination for patients with moderate-to-severe chronic obstructive pulmonary disease: a LANTERN population analysis from Singapore

“…(7) Despite these recommendations, ICSs are widely used for as many as one-third of GOLD Groups A and B patients with mild or moderate airflow limitation and/or 0-1 exacerbation per year with no hospitalisation for exacerbation. (8)(9)(10)(11)(12)(13) The overuse of ICSs increases the risk of side effects in these patients, (7,(14)(15)(16)(17)(18) thereby increasing the healthcare costs of COPD management. (7,8,13,14) The dual bronchodilator indacaterol/glycopyrronium (IND/GLY), a combination of LABA (indacaterol) and LAMA (glycopyrronium), is approved for maintenance treatment of COPD in Singapore.…”

“…(19,20) Although the guideline recommends the use of SFC for severe or very severe COPD (GOLD Groups C and/or D) with a history of repeated or severe exacerbations, (7) it is commonly used in low-risk patients in real-life practice. (8)(9)(10)(11)(12)(13) Evidence from the recently concluded LANTERN trial suggests that when compared to SFC, IND/GLY significantly reduced the rate of moderate or severe exacerbations by 31% in symptomatic GOLD Group B and D (53% and 47% of the total population, respectively) patients with a history of ≤ 1 exacerbation in the previous year (based on modified medical research council scores and lung function criteria). (20) In addition, the incidence of pneumonia was observed to be lower with IND/GLY than with SFC.…”