Determinants and predictors of the cost of COPD in primary care: A Spanish perspective

Javier de Miguel Diez¹, Pilar Carrasco Garrido², Marta García Carballo², Angel Gil de Miguel², Javier Rejas Gutierrez³, José M Bellón Cano⁴, Valentín Hernández Barrera², Rodrigo Jimenez García²

¹Department of Pneumology, University Hospital Gregorio Marañón, Madrid, Spain; ²School of Health Sciences, Rey Juan Carlos University, Alcorcón (Madrid), Spain; ³Health Outcomes Research Department Medical Unit, Pfizer Spain, Alcobendas (Madrid), Spain; ⁴Department of Preventive Medicine, University Hospital Gregorio Marañón, Madrid, Spain

Objectives: 1) To estimate the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) followed in primary care in Spain; 2) To analyze the possible cost predictor variables.

Patients and methods: A multicenter, epidemiological, observational, descriptive study. Sociodemographic data, severity of disease, associated comorbidity, treatment followed by patients, quality of life (SF-12 questionnaire), health care resource utilization in the previous 12 months and duration of working disability due to COPD were collected.

Results: A total of 10,711 patients (75.6% men; 24.4% women) with a mean age of 67.1 ± 9.66 years were evaluated. The mean forced expiratory volume in one second (FEV₁) value was 57.4 ± 13.4%. The total cost per patient per year was €1,922.60 ± 2,306.44. The largest component of this cost was hospitalization (€788.72 ± 1,766.65), followed by cost of drugs (€492.87 ± 412.15) and visits to emergency rooms (€134.32 ± 195.44). Linear regression analysis found associated heart disease, FEV₁, physical component of quality of life, number of medical visits (primary care physician, pneumologist and emergency room), hospital admissions (frequency and duration of stay) and duration of working disability to be significant predictors of the total annual cost.

Conclusions: The total annual cost of a COPD patient followed in primary care in Spain was considered high in this study. The presence of associated heart disease, severity of airflow obstruction, physical component of quality of life, health care resource utilization and duration of work disability were found to be predictor of cost.

Keywords: COPD, primary care, costs, predictors, Spain