Kamusheva Maria, Dimitrova Maria, van Boven Job F M, Postma Maarten J, van der Molen Thys, Kocks Janwillem W H, Mitov Konstantin, Doneva Miglena, Petrova Daniela, Georgiev Ognyan, Petkova Valentina, Petrova Guenka
a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria.
b Department of General Practice , Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.
J Med Econ. 2017 May;20(5):503-509. doi: 10.1080/13696998.2017.1279620. Epub 2017 Jan 23.
While the impact of COPD in Western-Europe is known, data from Eastern-Europe is scarce. This study aimed to evaluate clinical characteristics, treatment patterns, and the socio-economic burden of COPD in Eastern-Europe, taking Bulgaria as a reference case.
A representative sample of Bulgarian patients with COPD was randomly chosen by pulmonologists, based on the following inclusion criteria: COPD diagnosis with at least 1 year of living with COPD, ≥40 years of age, and use of COPD medication. Patient characteristics, treatment, quality-of-life, healthcare resource use, and costs were systematically assessed.
A total of 426 COPD patients were enrolled. Approximately 69% were male, 40% had occupational risk factors, 45% had severe and 11% had very severe COPD. Mean CAT scores were 13.80 (GOLD A), 21.80 (GOLD B), 17.35 (GOLD C), and 26.70 (GOLD D). Annual per-patient costs of healthcare utilization were €579. Yearly pharmacotherapy costs were €693. Indirect costs (reduced and lost work productivity) outnumbered direct costs three times.
Bulgaria has relatively high percentages of (very) severe COPD patients, resulting in considerable socio-economic burden. High smoking rates, occupational risk factors, air pollution, and a differential health system may be related to this finding. Eastern-European COPD strategies should focus on prevention, risk-factor awareness, and early detection.
虽然慢性阻塞性肺疾病（COPD）在西欧的影响已为人所知，但东欧的数据却很稀少。本研究旨在以保加利亚为例，评估东欧COPD的临床特征、治疗模式及社会经济负担。
肺病专家根据以下纳入标准随机选取保加利亚COPD患者的代表性样本：确诊COPD且患病至少1年、年龄≥40岁、正在使用COPD药物。系统评估患者的特征、治疗、生活质量、医疗资源使用及费用。
共纳入426例COPD患者。约69%为男性，40%有职业危险因素，45%为重度COPD，11%为极重度COPD。慢性阻塞性肺疾病评估测试（CAT）平均得分分别为：13.80（GOLD A级）、21.80（GOLD B级）、17.35（GOLD C级）和26.70（GOLD D级）。每位患者每年的医疗利用成本为579欧元。每年的药物治疗成本为693欧元。间接成本（工作效率降低和损失）是直接成本的三倍。
保加利亚（极）重度COPD患者比例相对较高，导致相当大的社会经济负担。高吸烟率、职业危险因素、空气污染及不同的卫生系统可能与此结果相关。东欧的COPD防治策略应侧重于预防、危险因素认知及早期检测。
