Lee Jongmin, Lee Jae Ha, Kim Jee-Ae, Rhee Chin Kook
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul.
Pharmaceutical Policy Evaluation Research Team, Research Institution, Health Insurance Review and Assessment Service, Wonju-si, Republic of Korea.
Int J Chron Obstruct Pulmon Dis. 2016 Dec 19;12:27-33. doi: 10.2147/COPD.S121687. eCollection 2017.
There are only a few longitudinal studies regarding medical utilization and costs for patients with COPD. The purpose of this study was to analyze the trend of medical utilization and costs on a long-term basis.
Using the Korean Health Insurance Review and Assessment Service (HIRA) data from 2008 to 2013, COPD patients were identified. The trend of medical utilization and costs was also analyzed.
The number of COPD patients increased by 13.9% from 2008 to 2013. During the same period, the cost of COPD medication increased by 78.2%. Methylxanthine and systemic beta agonists were most widely prescribed between 2008 and 2013. However, inhaled medications such as long-acting beta-2 agonist (LABA), long-acting muscarinic agonist, and inhaled corticosteroid plus LABA were dispensed to a relatively low proportion of patients with COPD. The number of patients who were prescribed inhaled medications increased gradually from 2008 to 2013, while the number of patients prescribed systemic beta agonist and methylxanthine has decreased since 2010.
This study shows that there is a large gap between the COPD guidelines and clinical practice in Korea. Training programs for primary care physicians on diagnosis and guideline-based treatment are needed to improve the management of COPD.
关于慢性阻塞性肺疾病（COPD）患者的医疗利用和费用的纵向研究较少。本研究的目的是长期分析医疗利用和费用的趋势。
利用韩国健康保险审查和评估服务（HIRA）2008年至2013年的数据，确定COPD患者。同时分析医疗利用和费用的趋势。
2008年至2013年，COPD患者数量增加了13.9%。同期，COPD药物费用增加了78.2%。2008年至2013年期间，甲基黄嘌呤和全身性β受体激动剂的处方最为广泛。然而，长效β2受体激动剂（LABA）、长效毒蕈碱受体激动剂以及吸入性糖皮质激素加LABA等吸入药物在COPD患者中的配给比例相对较低。从2008年到2013年，吸入药物处方患者数量逐渐增加，而自2010年以来，全身性β受体激动剂和甲基黄嘌呤处方患者数量有所下降。
本研究表明，韩国COPD指南与临床实践之间存在较大差距。需要为初级保健医生开展关于诊断和基于指南治疗的培训项目，以改善COPD的管理。
