Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD.
BACKGROUND
Although exacerbations are the main cause of medical visits and hospitalizations of patients with chronic bronchitis and COPD, little information is available on the costs of their management.


OBJECTIVE
This study attempted to determine the total direct costs derived from the management of exacerbations of chronic bronchitis and COPD in an ambulatory setting.


METHODS
A total of 2,414 patients with exacerbated chronic bronchitis and COPD were recruited from 268 general practices located throughout Spain. Patients were followed up for 1 month.


RESULTS
A total of 507 patients (21%) relapsed; of these, 161 patients (31.7%) required attention in emergency departments and 84 patients (16.5%) were admitted to the hospital. The total direct mean cost of all exacerbations was $159; patients who were hospitalized generated 58% of the total cost. Cost per failure was $477.50, and failures were responsible for an added mean cost of $100.30/exacerbation. Exacerbations of the 1,130 patients with COPD had a mean cost of $141. Sensitivity analysis showed that a 50% reduction in the failure rate (from 21 to 10.5%) would result in a total cost of exacerbation of $107 (33% reduction).


CONCLUSIONS
Exacerbations of chronic bronchitis and COPD are costly, but the greatest part of costs derives from therapeutic failures, particularly those that end in hospitalization.
Miravitlles
Marc
M
Center Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Barcelona. marcm@separ.es
Murio
Cristina
C
Guerrero
Tina
T
Gisbert
Ramon
R
D000208:Acute Disease; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D001991:Bronchitis / Q000191:economics*; D002908:Chronic Disease; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics*; D012008:Recurrence; D013030:Spain; D017211:Treatment Failure