PURPOSE: To estimate the annual COPD-related costs and health-related quality of life (HRQOL) in patients with moderate to severe COPD in Canada.
METHODS: Respirologists, internists, and family practitioners enrolled patients with an established diagnosis of moderate to severe COPD (GOLD stages II and III) confirmed by post-bronchodilator spirometry. Patient information and health care resources related to COPD maintenance and physician-documented exacerbations over the previous year were obtained by chart review and patient survey. Patients also completed the EuroQol 5 Dimensions (EQ-5D) once at enrolment. Unit costs (2009/2010$CAD) were applied to the resources.
RESULTS: A total of 285 patients (59.3% male; mean values: age 70.4 years; pack-years smoked 45.6; COPD duration 8.2 years; post-bronchodilator FEV1 58.0 % predicted) were enrolled by 23 sites across Canada. The average annual COPD-related cost per patient was $4,147 (95% confidence interval: $3,421 to $4,873). Across all 285 patients, maintenance cost was $2,475 and treatment of exacerbation cost was $1,673. Ninety-eight patients (34%) experienced a total of 157 exacerbations. Treatment of these exacerbations included medications and outpatient care, 19 emergency room visits and 40 hospitalizations (mean length of stay 8.9 days). The mean cost per exacerbation was $3,036. The mean EQ-5D utility and EQ visual analogue scale (VAS) scores were 0.74 and 68.25, respectively. Both the EQ-5D and EQ VAS scores were correlated with COPD-related total costs and maintenance costs (p±0.01), but neither were correlated with the FEV1 % predicted, nor with the exacerbation costs.
CONCLUSION: The annual cost of maintenance and exacerbation therapy of GOLD stages II and III COPD patients was substantial to the Canadian health care system. Patient health-related quality of life was related to health care utilization for COPD, but was not related to impairment in lung function.
CLINICAL IMPLICATIONS: New interventions that can mitigate COPD-related events may be cost-effective. HRQOL questionnaires have value in clinical practice.
DISCLOSURE: M. Reza Maleki-Yazdi, Grant monies (from sources other than industry) Dr. Sy Lam has received honoraria for advisory, speech or organizational works from Alberta Health Services and University of Calgary.; Grant monies (from industry related sources) Dr. Maleki has received honoraria from Novartis, GlaxoSmithKline, Boehringer Ingelheim, AstraZeneca, and Pfizer. Dr. Lam has received honoraria or research grants from Novartis Pharmaceuticals Canada Inc., AstraZeneca Canada Inc., Merck Frosst Canada Ltd., Pfizer Canada Inc., Novo Nordisk Canada Inc., Boehringer Ingelheim (Canada) Ltd., Daiichi Sankyo Pharma Development, Bristol-Myers Squibb Canada Inc., Takeda Global Research & Development Centre, Inc., Sanofi Aventis Canada Inc., Debiopharm S.A., GlaxoSmithKline Inc., Enanta Pharmaceuticals Inc., Bayer Inc., Hoffmann-La Roche Limited, Servier Canada Inc., Eli Lilly Canada, NeurogesX, Inc., Nycomed Canada Inc., Extendicare Canada, Wyeth Canada, Sepracor Pharmaceuticals, Inc., Janssen Ortho Inc., Lundbeck Canada Inc., Bayer HealthCare., Schering-Plough Canada Inc., Proctor & Gamble Pharmaceuticals Canada Inc., Abbott Laboratories Ltd, Biovail Pharmaceuticals.; Shareholder Suzanne Kelly holds shares and stock options in Novartis Pharmaceuticals Canada.; Employee Heide Hass, Martin Barbeau and Suzanne Kelly are employed by Novartis Pharmaceuticals Canada.; Consultant fee, speaker bureau, advisory committee, etc. Valery Walker and Raina Rogoza are paid consultants for Novartis Pharmaceuticals Canada.; No Product/Research Disclosure Information