Economic Burden of COPD by Disease Severity – A Nationwide Cohort Study in Denmark
Received 3 December 2020
Accepted for publication 22 February 2021
Published 10 March 2021 Volume 2021:16 Pages 603—613
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Anders Løkke,1,2 Peter Lange,3,4 Jesper Lykkegaard,5 Rikke Ibsen,6 Maria Andersson,7 Sofie de Fine Licht,8 Ole Hilberg1,2
1Department of Medicine, Little Belt Hospital, Vejle, Denmark; 2Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 3Medical Department, Copenhagen University Hospital-Herlev, Herlev, Denmark; 4Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark; 5Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark; 6i2Minds, Aarhus, Denmark; 7AstraZeneca Nordic, IVS & Health Economics, Södertälje, Sweden; 8AstraZeneca Nordic,Medical & Regulatory, Södertälje, Sweden
Correspondence: Anders Løkke
University of Southern Denmark, Odense, Denmark
Email [email protected]
Background: Chronic Obstructive Pulmonary Disease (COPD) carries a considerable economic burden, both for individuals and societies. This study aimed to assess direct and indirect costs associated with COPD, and how costs vary across disease severity.
Methods: This was a nationwide, population-based cohort study utilizing Danish health registries. Patients; ≥ 40 years of age, with an in- and/or outpatient diagnosis of COPD (ICD-10 J44) in 2008– 2016, were identified in the nationwide Danish COPD Registry. Included patients were matched 1:4 to a population-based non-COPD reference population of 196,623 individuals by sex, year of birth, co-habitation status, and municipality. Patients were grouped by disease severity according to different characteristics including GOLD groups A-D, based on moderate (short-term oral corticosteroid use), presence of severe exacerbations (emergency visit or hospitalization) and symptom score. Index was the date of the first outpatient visit with a symptom score registration. The costs were calculated during a 12 months post-index follow-up.
Results: In all, 49,826 patients with COPD (mean age 69.2 years, 52% females) were included. Total annual costs, including direct costs, costs for elderly care, and costs for retirement home, were higher for patients with COPD (€ 28,969) compared with the reference population (€ 10,6913). In GOLD groups A-D, the total direct costs were A: € 8,766, B: € 13,060, C: € 11,113, and D: € 17,749, respectively. A major driver of direct costs was severe exacerbations. The mean costs per moderate and severe exacerbation were € 888 and € 7,091, respectively, during 28 days of follow-up. The costs for non-COPD-related Health Care Resource Utilization were higher than the COPD-related costs in GOLD groups A-C, but not in GOLD group D.
Conclusion: In this nationwide real-world study, total direct costs were three-fold higher among patients with COPD compared with the reference population. Severe exacerbations were a major driver of the direct costs. The costs increased with increasing disease severity.
Keywords: COPD, exacerbations, symptoms, cost, GOLD
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]