title: The excess cost of acute exacerbations of chronic bronchitis in patients aged 45 and older in England and Wales.
abstract: BACKGROUND
  Chronic Bronchitis is a serious and costly health problem. Prevalence is estimated at 45 per 10,000 persons in the United Kingdom. Approximately 120,000 Pounds would be saved for every 100 hospital admissions avoided. A reduction in acute exacerbations of chronic bronchitis (AECB), treatment failures, and subsequent hospital admission could have a significant impact on the burden of AECB borne by secondary care facilities in the UK National Health Service (NHS).
  
  
  OBJECTIVE
  The aim of this study is to provide an economic assessment of the direct cost to the health care system associated with the management of chronic bronchitis and its acute exacerbations.
  
  
  METHODS
  A prevalence-based, excess-cost-of-illness analysis is undertaken from the perspective of the UK NHS. Disease prevalence data, primary health care resource utilization, hospital inpatient and outpatient resource utilization, and costs of health care were taken from a variety of data sources, including a large UK national survey of general practice (GP) consultations, the General Practice Research Database, a survey from a single NHS hospital trust, and the national health-care resource and cost statistics.
  
  
  RESULTS
  From 1994 to 1995, approximately 233,000 cases of chronic bronchitis were detected in the persons aged 45 and older in the United Kingdom. Prevalence peaked at 204 per 10,000 in the group of subjects aged 75 to 84 years. During that same period, the total excess cost of primary care associated with AECB was calculated at 35.7 million Pounds. The largest component of primary care costs was the excess cost of all prescription medicines, which totaled 27.8 million Pounds. The excess cost attributed to antibacterial and respiratory prescription medications alone was estimated at 9 million Pounds. Excess costs attributed to GP consultations and hospital emergency room visits were 6.5 million Pounds and 1.3 million Pounds, respectively. The excess costs arising from inpatient hospital episodes included 8.3 million Pounds for hospital admissions, 660,000 Pounds for outpatient costs, and 225,000 Pounds for day care.
  
  
  CONCLUSIONS
  These results suggest that improving the management of AECB with the objective of reducing the number of AECB treatment failures and the associated hospital admissions could significantly reduce expenditures by the UK NHS.
authors.affiliation: City University, Northampton Square, London, England, UK.
authors.forename: A
authors.initials: A
authors.lastname: McGuire
authors.forename: D E
authors.initials: DE
authors.lastname: Irwin
authors.forename: P
authors.initials: P
authors.lastname: Fenn
authors.forename: A
authors.initials: A
authors.lastname: Gray
authors.forename: P
authors.initials: P
authors.lastname: Anderson
authors.forename: A
authors.initials: A
authors.lastname: Lovering
authors.forename: A
authors.initials: A
authors.lastname: MacGowan
mesh_terms: D000368:Aged; D029481:Bronchitis, Chronic / Q000150:complications / Q000191:economics* / Q000453:epidemiology; D017281:Cost of Illness; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D013222:State Medicine / Q000191:economics* / Q000706:statistics & numerical data*; D017211:Treatment Failure; D014852:Wales / Q000453:epidemiology