Costs of chronic obstructive pulmonary disease (COPD) in Italy: The SIRIO study (Social Impact of Respiratory Integrated Outcomes)

Abstract

Chronic respiratory diseases affect a large number of subjects in Italy and are characterized by high socio-health costs. The aim of the Social Impact of Respiratory Integrated Outcomes (SIRIO) study was to measure the health resources consumption and costs generated in 1 year by a population of patients with chronic obstructive pulmonary disease (COPD) in a real-life setting. This bottom-up, observational, prospective, multicentric study was based on the collection of demographic, clinical, diagnostic, therapeutic and outcome data from COPD patients who reported spontaneously to pneumological centers participating in the study, the corresponding economic outcomes being assessed at baseline and after a 1-year survey. A total of 748 COPD patients were enrolled, of whom 561 [408 m, mean age 70.3 years (SD 9.2)] were defined as eligible by the Steering Committee. At the baseline visit, the severity of COPD (graded according to GOLD 2001 guidelines) was 24.2% mild COPD, 53.7% moderate and 16.8% severe. In the 12 months prior to enrollment, 63.8% visited a general practitioner (GP); 76.8% also consulted a national health service (NHS) specialist; 22.3% utilized Emergency Care and 33% were admitted to hospital, with a total of 5703 work days lost. At the end of the 1-year survey, the severity of COPD changed as follows: 27.5% mild COPD, 47.4% moderate and 19.4% severe. Requirement of health services dropped significantly: 57.4% visited the GP; 58.3% consulted an NHS specialist; 12.5% used Emergency Care and 18.4% were hospitalized. Compared to baseline, the mean total cost per patient decreased by 21.7% (p<0.002). In conclusion, a significant reduction in the use of health resources and thus of COPD-related costs (both direct and indirect costs) was observed during the study, likely due to a more appropriate care and management of COPD patients.

Pharmacoeconomic evaluation of tiotropium bromide in the long-term treatment of chronic obstructive pulmonary disease (COPD) in Italy

“…The characteristics of the COPD population are extracted from four Italian observational studies: the SIRIO study, a recent and large observational study on 561 COPD patients from 32 respiratory medicine centers [14], the cohort study by Koleva and colleagues enrolling 268 COPD patients from 11 Italian respiratory medicine departments [8], the ICE (Italian Costs for Exacerbations in COPD) prospective analysis conducted on 570 patients followed for 6 months after a COPD exacerbation [9] and the earlier multicenter cohort survey ''Salute Respiratoria nell'Anziano'' (SaRA), which investigated various aspects of chronic airway diseases in the elderly population attending pulmonary or geriatrics outpatient clinics [15]. Most patient characteristics, like gender, age, smoking status and PB-FEV1, are taken from the SIRIO cohort, deemed as the most representative of the general COPD population for its numerousness and broad inclusion criteria [14].…”

“…Most patient characteristics, like gender, age, smoking status and PB-FEV1, are taken from the SIRIO cohort, deemed as the most representative of the general COPD population for its numerousness and broad inclusion criteria [14]. Some parameters were inadequately detailed in SIRIO for our modeling purposes, so we relied on the best available alternative source: GOLD stage-specific exacerbation rates were taken from Koleva et al [8], QoL utilities from SaRA [15], while cost structure was modeled according to ICE and Koleva et al [8,9].…”

“…The distributions of initial patient characteristics in the simulated population [14] are presented in Table 1. Patients are divided into smokers and ex-smokers, while the ''never smoker'' status was not considered since this category of COPD patients was not included in the recruitment protocol of the UPLIFTÒ study and all other main tiotropium bromide RCTs [10,12,[16][17][18][19][20][21][22][23].…”

Essential amino acid supplementation in patients with severe COPD: a step towards home rehabilitation

“…Chronic Obstructive Pulmonary Disease (COPD) has a great medical and social impact on public health in Italy as at least 10% of general population is affected by COPD [1]; more than 15% of these subjects is suffering from severe COPD [2], and they presumably are living in disabled conditions.…”

Varenicline treatment for smoking cessation in high risk patients: a budget impact analysis

“…As for the estimate of the savings resulting from the cessations, this was done separately, for each disease branch 1 . The average annual cost per COPD patient was assumed to be € 2,723.7 [19]; the estimate for the smoking and non-smoking population was carried out by adopting the savings ratio collected by Sicras-Mainar [6] from a cohort of Spanish patients with COPD specifically treated to promote smoking cessation, which highlighted a cost of € 3.775,4 per smoking patient and € 2,382.4 per no longer smoking patient, with an average annual saving per capita resulting from the cessation of € 1,393.0. Through a similar procedure, patients with diabetes are assumed to have a mean annual cost per patient of € 2,898.0 [20].…”