Study objectives: The clinical outcomes and health-care
costs of a cohort of 413 patients with COPD are reported.
Design: This study was a retrospective pharmacoeconomic
Setting: University teaching hospital and
Patients: COPD patients with an
FEV1 < 65% of predicted and an FEV1/FVC
ratio < 70% were eligible to be included in this analysis.
Interventions: Health-care resource utilization and costs
were identified through chart review and were stratified according to
the severity of COPD using the American Thoracic Society stages I, II,
and III. The pharmacoeconomic analysis was a cost-of-illness evaluation
that included the acquisition costs of initially prescribed pulmonary
drugs, acquisition cost of pulmonary drugs added during the follow-up
period, oxygen therapy, laboratory and diagnostic test costs, clinic
visit costs, and emergency department and hospital costs.
Results: Total treatment cost was highly correlated with
disease severity, with stage I COPD having the lowest cost ($1,681 per
patient per year), stage III COPD having the highest cost ($10,812 per
patient per year), and stage II COPD having a cost intermediate to
stage I and stage III ($5,037 per patient per year). With the exception
of add-on drug acquisition cost, all cost variables were the highest in
stage III COPD, the lowest in stage I COPD, and intermediate in stage
II COPD. Hospitalization was the most important cost variable for all
three stages of COPD severity. When stratified by both disease severity
and initial bronchodilator drug selection, ipratropium alone in stage I
COPD patients and the combination of ipratropium plus a β-agonist
(with or without steroid therapy) in stage II and stage III COPD
patients had the lowest total costs. Reasons for the lower total cost
of the ipratropium and ipratropium plus β-agonist treatment groups
included lower add-on drug costs, fewer diagnostic and laboratory
tests, and a lower utilization rate for clinic visits, emergency
department visits, and hospitalizations.
Our study demonstrates a strong correlation between disease severity
and total treatment cost in COPD. In addition, the type of
bronchodilator therapy impacts total cost in COPD. In stage I COPD,
ipratropium alone had the lowest total cost, while in stage II and
stage III COPD, a combination of ipratropium plus a β-agonist had the
lowest total cost. These data support the concept that adherence to
published treatment guidelines will result in lower health-care costs
due to COPD.