The contribution of symptoms and comorbidities to the economic impact of COPD: an analysis of the German COSYCONET cohort

Abstract

BackgroundAlthough patients with COPD often have various comorbidities and symptoms, limited data are available on the contribution of these aspects to health care costs. This study analyzes the association of frequent comorbidities and common symptoms with the annual direct and indirect costs of patients with COPD.MethodsSelf-reported information on 33 potential comorbidities and symptoms (dyspnea, cough, and sputum) of 2,139 participants from the baseline examination of the German COPD cohort COSYCONET was used. Direct and indirect costs were calculated based on self-reported health care utilization, work absence, and retirement. The association of comorbidities, symptoms, and COPD stage with annual direct/indirect costs was assessed by generalized linear regression models. Additional models analyzed possible interactions between COPD stage, the number of comorbidities, and dyspnea.ResultsUnadjusted mean annual direct costs were €7,263 per patient. Other than COPD stage, a high level of dyspnea showed the strongest driving effect on direct costs (+33%). Among the comorbidities, osteoporosis (+38%), psychiatric disorders (+36%), heart disease (+25%), cancer (+24%), and sleep apnea (+21%) were associated with the largest increase in direct costs (p<0.01). A sub-additive interaction between advanced COPD stage and a high number of comorbidities reduced the independent cost-driving effects of these factors. For indirect costs, besides dyspnea (+34%), only psychiatric disorders (+32%) and age (+62% per 10 years) were identified as significant drivers of costs (p<0.04). In the subsequent interaction analysis, a high number of comorbidities was found to be a more crucial factor for increased indirect costs than single comorbidities.ConclusionDetailed knowledge about comorbidities in COPD is useful not only for clinical purposes but also to identify relevant cost factors and their interactions and to establish a ranking of major cost drivers. This could help in focusing therapeutic efforts on both clinically and economically important comorbidities in COPD.

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“…A cross-sectional study conducted in the French Initiatives COPD cohort provided evidence that current cough in the previous 7 days was an important determinant of health-related QoL impairment in stable COPD patients 34. Nevertheless, previous studies had not demonstrated association of cough and mucus production with increased direct health care costs in COPD patients 35…”

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“…These multidimensional factors can strongly contribute to and perpetuate cognitive impairments and psychological symptoms, create barriers to adaptive health behaviours and significantly contribute to the burden of the disease, affecting quality of life often in a downward spiral [11,12]. The net effects are substantial reductions in the quality of life for those with chronic respiratory disease, their families and informal caregivers [12,13], together with high socioeconomic costs [14].…”

Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD

“…Furthermore, these psychological disorders are often underdiagnosed and undertreated in patients with COPD [8,12,13]. High levels of anxiety and depression are associated with reduced quality of life [14], increased costs to the healthcare system [15,16], and increased mortality [17,18]. Furthermore, anxiety and depression are associated with reduced functional exercise capacity and increased dyspnea [19,20], increased hospitalizations and COPD exacerbations [21,22,23,24], as well as unfavorable health behaviors including reduced self-reported medication adherence [25], and increased levels of smoking and physical inactivity [26].…”