Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review

Ike Iheanacho, Shiyuan Zhang, Denise King, Maria Rizzo, Afisi S Ismaila, Ike Iheanacho, Shiyuan Zhang, Denise King, Maria Rizzo, Afisi S Ismaila

Abstract

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; economic burden; healthcare utilization; review; systematic literature review.

Conflict of interest statement

The authors declare the following conflicts of interest during the last 3 years in relation to this article: SZ and ASI are employees of, and hold shares in, GlaxoSmithKline plc.; ASI is also a part-time unpaid professor at McMaster University, Canada. Evidera (II) was contracted by GlaxoSmithKline plc. to conduct the systematic literature review but was not paid for the development of this manuscript. MR is an employee of Xcenda UK and was previously employed by Evidera and contracted by GlaxoSmithKline plc. to conduct the systematic literature review but was not paid for the development of this publication. DK is a former GlaxoSmithKline plc. employee and is currently employed by Forest Systematic Reviews Ltd, contracted by GlaxoSmithKline plc. The authors report no other conflicts of interest in this work.

© 2020 Iheanacho et al.

Figures

Figure 1
Figure 1
Identification of studies for inclusion in the systematic literature review (following systematic processes outlined in PRISMA guidelines). Note: Adapted from Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Location of included studies. Notes: Australia (n=3), Canada (n=4), France (n=2), Germany (n=1), Italy (n=8), Japan (n=2), Spain (n=14), UK (n=14), US (n=31). Some publications reported data from multiple countries. Abbreviations: UK, United Kingdom; US, United States.
Figure 3
Figure 3
Number of studies reporting on each outcome. Abbreviation: HRU, healthcare resource utilization.

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