Blasi Francesco, Cesana Giancarlo, Conti Sara, Chiodini Virginio, Aliberti Stefano, Fornari Carla, Mantovani Lorenzo Giovanni
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano - Bicocca, Monza, Italy.
PLoS One. 2014 Jun 27;9(6):e101228. doi: 10.1371/journal.pone.0101228. eCollection 2014.
Chronic Obstructive Pulmonary Disease (COPD) is a common disease with significant health and economic consequences. This study assesses the burden of COPD in the general population, and the influence of exacerbations (E-COPD) on disease progression and costs.
This is a secondary data analysis of healthcare administrative databases of the region of Lombardy, in northern Italy. The study included ≥ 40 year-old patients hospitalized for a severe E-COPD (index event) during 2006. Patients were classified in relation to the number and type of E-COPD experienced in a three-year pre-index period. Subjects were followed up until December 31st, 2009, collecting data on healthcare resource use and vital status.
15857 patients were enrolled -9911 males, mean age: 76 years (SD 10). Over a mean follow-up time of 2.4 years (1.36), 81% of patients had at least one E-COPD with an annual rate of 3.2 exacerbations per person-year and an all-cause mortality of 47%. A history of exacerbation influenced the occurrence of new E-COPD and mortality after discharge for an E-COPD. On average, the healthcare system spent 6725€ per year per person (95%CI 6590-6863). Occurrence and type of exacerbations drove the direct healthcare cost. Less than one quarter of patients presented claims for pulmonary function tests.
COPD imposes a substantial burden on healthcare systems, mainly attributable to the type and occurrence of E-COPD, or in other words, to the exacerbator phenotypes. A more tailored approach to the management of COPD patients is required.
慢性阻塞性肺疾病（COPD）是一种常见疾病，对健康和经济造成重大影响。本研究评估了普通人群中COPD的负担，以及急性加重（E-COPD）对疾病进展和成本的影响。
这是对意大利北部伦巴第地区医疗管理数据库的二次数据分析。该研究纳入了2006年期间因严重E-COPD（索引事件）住院的≥40岁患者。根据索引事件前三年中经历的E-COPD的数量和类型对患者进行分类。对受试者进行随访至2009年12月31日，收集医疗资源使用和生命状态数据。
共纳入15857例患者，其中男性9911例，平均年龄76岁（标准差10）。在平均2.4年（1.36）的随访时间内，81%的患者至少发生一次E-COPD，每人每年急性加重率为3.2次，全因死亡率为47%。急性加重史影响新的E-COPD的发生以及E-COPD出院后的死亡率。平均而言，医疗系统每人每年花费6725欧元（95%可信区间6590-6863）。急性加重的发生和类型决定了直接医疗成本。不到四分之一的患者进行了肺功能测试。
COPD给医疗系统带来了沉重负担，主要归因于E-COPD的类型和发生情况，换句话说，归因于急性加重表型。需要对COPD患者采取更具针对性的管理方法。
