Department of Medicine, Little Belt Hospital, Vejle, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Int J Chron Obstruct Pulmon Dis. 2021 Mar 10;16:603-613. doi: 10.2147/COPD.S295388. eCollection 2021.
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.
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.
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.
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.
慢性阻塞性肺疾病（COPD）给个人和社会都带来了相当大的经济负担。本研究旨在评估与 COPD 相关的直接和间接成本，以及成本如何因疾病严重程度而变化。
这是一项全国性的基于人群的队列研究，利用丹麦健康登记处的数据。2008-2016 年，在全国性的丹麦 COPD 登记处中，通过 ICD-10 J44 对≥40 岁的门诊和/或住院诊断为 COPD 的患者进行了识别。纳入的患者根据性别、出生年份、同居状况和市与全国性非 COPD 参考人群中年龄、性别匹配的 196623 名个体进行了 1:4 匹配。根据不同特征，包括 GOLD 组 A-D，根据中度（短期口服皮质类固醇使用）、严重加重的存在（急诊就诊或住院）和症状评分，将患者分为疾病严重程度组。指数为首次出现症状评分登记的门诊就诊日期。在索引后 12 个月的随访期间计算了成本。
共纳入 49826 例 COPD 患者（平均年龄 69.2 岁，52%为女性）。与参考人群（€106913）相比，COPD 患者的总年度费用（包括直接费用、老年护理费用和养老院费用）更高（€28969）。在 GOLD 组 A-D 中，直接总费用分别为 A：€8766、B：€13060、C：€11113 和 D：€17749。严重加重是直接费用的主要驱动因素。在 28 天的随访期间，中度和重度加重的平均费用分别为€888 和€7091。非 COPD 相关医疗资源利用的费用高于 GOLD 组 A-C 中的 COPD 相关费用，但在 GOLD 组 D 中则不然。
在这项全国范围内的真实世界研究中，COPD 患者的直接总费用是参考人群的三倍。严重加重是直接费用的主要驱动因素。随着疾病严重程度的增加，成本也会增加。
