COPD symptom burden: impact on health care resource utilization, and work and activity impairment
Authors Ding B, Small M, Bergström G, Holmgren U
Received 5 October 2016
Accepted for publication 28 December 2016
Published 21 February 2017 Volume 2017:12 Pages 677—689
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Charles Downs
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Bo Ding,1 Mark Small,2 Gina Bergström,3 Ulf Holmgren3
1Medical Evidence and Observational Research, AstraZeneca Gothenburg, Mölndal, Sweden; 2Real World Research (Respiratory), Adelphi Real World, Bollington, UK; 3Global Payer Evidence and Pricing, AstraZeneca Gothenburg, Mölndal, Sweden
Background: Chronic obstructive pulmonary disease (COPD) can greatly impact the quality of life by limiting patients’ activities. However, data on impact of symptomatic burden on the health care resource utilization (HCRU) and employment in COPD are lacking. We examined the association between COPD Assessment Test (CAT) score and direct/indirect costs associated with HCRU and work productivity.
Methods: Data from >2,100 patients with COPD consulting for routine care were derived from respiratory disease-specific programs in Europe, the USA and China. Questionnaires, including CAT and Work Productivity and Activity Impairment (WPAI), were used to collect the past and current disease status data and HCRU characteristics from physicians (general practitioners/specialists) and patients. A regression approach was used to quantify the association of CAT with HCRU and WPAI variables. CAT score was modeled as a continuous independent variable (range: 0–40).
Results: Ninety percent of patients with COPD had a CAT score ≥10. Short-acting therapy and maintenance bronchodilator monotherapy, respectively, were currently prescribed to patients with CAT scores of 10–19 (5.8% and 27.6%), 20–29 (5.1% and 13.1%) and 30–40 (2.8% and 6.6%). Prescribing of maintenance bronchodilator dual therapy was low across the CAT score groups (0–9, 7.8%; 10–19, 6.4%; 20–29, 5.9%; 30–40, 4.4%), whereas maintenance triple combination therapy was prescribed more commonly in patients with higher CAT scores (0–9, 16.1%; 10–19, 23.2%; 20–29, 25.9%; 30–40, 35.5%). Increasing CAT scores were significantly associated with a higher frequency of primary care physician visits (P<0.001), pulmonologist visits (P=0.007), exacerbations requiring hospitalization (P<0.001) and WPAI scores (P<0.001).
Conclusion: Most patients with COPD presented with high symptom levels, despite being treated for COPD. Increasing symptom burden was associated with increasing HCRU and had a detrimental impact on work productivity.
Keywords: COPD, symptom, health care resource utilization, work and activity impairment, routine care
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