Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review
Received 17 October 2019
Accepted for publication 24 January 2020
Published 26 February 2020 Volume 2020:15 Pages 439—460
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Ike Iheanacho,1 Shiyuan Zhang,2 Denise King,3 Maria Rizzo,1 Afisi S Ismaila2,4
1Meta Research, Evidera, London, UK; 2Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA; 3Value Evidence and Outcomes, GlaxoSmithKline plc., Brentford, UK; 4Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
Correspondence: Afisi S Ismaila
Value Evidence and Outcomes, GlaxoSmithKline plc., 1250 South Collegeville Road, Collegeville, PA 19426-0989, USA
Tel +1 919 315 8229
Background and Objectives: Chronic obstructive pulmonary disease (COPD) affects over 250 million people globally, carrying a notable economic burden. This systematic literature review aimed to highlight the economic burden associated with moderate-to-very severe COPD and to investigate key drivers of healthcare resource utilization (HRU), direct costs and indirect costs for this patient population.
Materials and Methods: Relevant publications published between January 1, 2006 and November 14, 2016 were captured from the Embase, MEDLINE and MEDLINE In-Process databases. Supplemental searches from relevant 2015– 2016 conferences were also performed. Titles and abstracts were reviewed by two independent researchers against pre-defined inclusion and exclusion criteria. Studies were grouped by the type of economic outcome presented (HRU or costs). Where possible, data were also grouped according to COPD severity and/or patient exacerbation history.
Results: In total, 73 primary publications were included in this review: 66 reported HRU, 22 reported direct costs and one reported indirect costs. Most of the studies (94%) reported on data from either Europe or North America. Trends were noted across multiple studies for higher direct costs (including mean costs per patient per year and mean costs per exacerbation) being associated with increasingly severe COPD and/or a history of more frequent or severe exacerbations. Similar trends were noted according to COPD severity and/or exacerbation history for rate of hospitalization and primary care visits. Multivariate analyses were reported by 29 studies and demonstrated the statistical significance of these associations. Several other drivers of increased costs and HRU were highlighted for patients with moderate-to-very severe COPD, including comorbidities, and treatment history.
Conclusion: Moderate-to-very severe COPD represents a considerable economic burden for healthcare providers despite the availability of efficacious treatments and comprehensive guidelines on their use. Further research is warranted to ensure cost-efficient COPD management, to improve treatments and ease budgetary pressures.
Keywords: chronic obstructive pulmonary disease, cost of illness, healthcare utilization, review, systematic literature review, economic burden
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