Economic Burden of COPD by Disease Severity - A Nationwide Cohort Study in Denmark

Anders Løkke, Peter Lange, Jesper Lykkegaard, Rikke Ibsen, Maria Andersson, Sofie de Fine Licht, Ole Hilberg, Anders Løkke, Peter Lange, Jesper Lykkegaard, Rikke Ibsen, Maria Andersson, Sofie de Fine Licht, Ole Hilberg

Abstract

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; GOLD; cost; exacerbations; symptoms.

Conflict of interest statement

A.L., J.L., R.I., and O.H. report no conflict of interests in relations to the current study. P.L. has participated in advisory boards for AstraZeneca, Boehringer Ingelheim, Chiesi and GSK, and has received research grants from AstraZeneca, Boehringer Ingelheim and GSK. M.A. and S.dFL. are full-time employees of AstraZeneca. The authors report no other conflicts of interest in this work.

© 2021 Løkke et al.

Figures

Figure 1
Figure 1
Diagram showing flow of study participants and final study cohort size.
Figure 2
Figure 2
Direct costs in euro (€) in COPD patients, presented as COPD-related and non-COPD-related costs and stratified by GOLD group.

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